Polymyalgia rheumatica medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
==Medical Therapy== | ==Medical Therapy== | ||
* The mainstay of treatment of PMR is low dose [[glucocorticoids]], typically [[prednisone]] or [[prednisolone]]: | |||
** The starting dose is 15-20 mg daily for 2 to 4 weeks | |||
** Gradually taper the [[steroid]] by decreasing the dose by 2.5 mg every 2 to 4 weeks | |||
** When the dose is 10 mg daily, decrease the dose by 1 mg every month | |||
* There should be close attention to the occurrence of symptoms of [[giant cell arteritis]]. Higher dose of [[glucocorticoids]] (40 mg daily) is indicated when patients with PMR develop [[giant cell artertitis]] | |||
* During the treatment, the subject's response to treatment should be monitored through: | |||
** Clinical symptoms | |||
** Measurement of [[ESR]] and [[CRP]] | |||
* Treatment lasts as long as needed; however, it normally takes patients several years to get off of the [[steroids]]. The symptoms may come back when the dosage is lowered. The average duration of the treatment with [[glucocorticoids]] is 1 to 2 years; nevertheless, longer [[corticosteroids]] regimens might be necessary among patients who experience relapse of the symptoms. | |||
* Studies have shown that [[steroids]] increase the patient’s [[blood pressure]]. For this reason, the patient’s [[blood pressure]] is monitored throughout the treatment process. Also, the [[steroids]] lower the patient’s [[immune system]], making them more susceptible to [[infection]]. The doctor should be notified of any signs of sickness. | |||
* Prophylaxis for [[osteoporosis]] with [[calcium]] and [[vitamin D]] should be started along with [[steroid]] therapy. | |||
=== Other therapies === | === Other therapies === | ||
*[[Methotrexate]] is the commonly used steroid sparing agent.[[Prednisone]] plus [[methotrexate]] treatment is associated with shorter [[prednisone]] treatment.<ref name="pmid15466766">{{cite journal |author=Caporali R, Cimmino MA, Ferraccioli G, ''et al.'' |title=Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial |journal=Ann. Intern. Med. |volume=141 |issue=7 |pages=493–500 |year=2004 |month=October |pmid=15466766 |doi= |url=}}</ref> | *[[Methotrexate]] is the commonly used steroid sparing agent.[[Prednisone]] plus [[methotrexate]] treatment is associated with shorter [[prednisone]] treatment.<ref name="pmid15466766">{{cite journal |author=Caporali R, Cimmino MA, Ferraccioli G, ''et al.'' |title=Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial |journal=Ann. Intern. Med. |volume=141 |issue=7 |pages=493–500 |year=2004 |month=October |pmid=15466766 |doi= |url=}}</ref> | ||
*[[Infliximab]] use in [[[PMR]] has not been proved beneficial and it may be harmful.<ref name="pmid17470831">{{cite journal |author=Salvarani C, Macchioni P, Manzini C, ''et al.'' |title=Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial |journal=Ann. Intern. Med. |volume=146 |issue=9 |pages=631–9 |year=2007 |month=May |pmid=17470831 |doi= |url=}}</ref> | *[[Infliximab]] use in [[[PMR]] has not been proved beneficial and it may be harmful.<ref name="pmid17470831">{{cite journal |author=Salvarani C, Macchioni P, Manzini C, ''et al.'' |title=Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial |journal=Ann. Intern. Med. |volume=146 |issue=9 |pages=631–9 |year=2007 |month=May |pmid=17470831 |doi= |url=}}</ref> | ||
*[[Etanercept]] may be safe and useful in relapsing [[PMR]]. It is modestly effective in [[PMR]] associated with [[ | *[[Etanercept]] may be safe and useful in relapsing [[PMR]]. It is modestly effective in [[PMR]] associated with [[giant cell arteritis]] than in isolated [[PMR]]. Trials are still in progress to determine the benefit and the differences in response. | ||
==References== | ==References== | ||
Revision as of 02:20, 2 June 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
- The mainstay of treatment of PMR is low dose glucocorticoids, typically prednisone or prednisolone:
- The starting dose is 15-20 mg daily for 2 to 4 weeks
- Gradually taper the steroid by decreasing the dose by 2.5 mg every 2 to 4 weeks
- When the dose is 10 mg daily, decrease the dose by 1 mg every month
- There should be close attention to the occurrence of symptoms of giant cell arteritis. Higher dose of glucocorticoids (40 mg daily) is indicated when patients with PMR develop giant cell artertitis
- During the treatment, the subject's response to treatment should be monitored through:
- Treatment lasts as long as needed; however, it normally takes patients several years to get off of the steroids. The symptoms may come back when the dosage is lowered. The average duration of the treatment with glucocorticoids is 1 to 2 years; nevertheless, longer corticosteroids regimens might be necessary among patients who experience relapse of the symptoms.
- Studies have shown that steroids increase the patient’s blood pressure. For this reason, the patient’s blood pressure is monitored throughout the treatment process. Also, the steroids lower the patient’s immune system, making them more susceptible to infection. The doctor should be notified of any signs of sickness.
- Prophylaxis for osteoporosis with calcium and vitamin D should be started along with steroid therapy.
Other therapies
- Methotrexate is the commonly used steroid sparing agent.Prednisone plus methotrexate treatment is associated with shorter prednisone treatment.[1]
- Infliximab use in [[[PMR]] has not been proved beneficial and it may be harmful.[2]
- Etanercept may be safe and useful in relapsing PMR. It is modestly effective in PMR associated with giant cell arteritis than in isolated PMR. Trials are still in progress to determine the benefit and the differences in response.
References
- ↑ Caporali R, Cimmino MA, Ferraccioli G; et al. (2004). "Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial". Ann. Intern. Med. 141 (7): 493–500. PMID 15466766. Unknown parameter
|month=ignored (help) - ↑ Salvarani C, Macchioni P, Manzini C; et al. (2007). "Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial". Ann. Intern. Med. 146 (9): 631–9. PMID 17470831. Unknown parameter
|month=ignored (help)