Polymyalgia rheumatica medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The mainstay of treatment of polymyalgia rheumatica (PMR) is low dose [[glucocorticoids]], typically [[prednisone]] or [[prednisolone]]. The starting dose of the [[glucocorticoid]] treatment is 15-20 mg daily for 2 to 4 weeks after which the treatment should be slowly tapered. 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. Prophylaxis for [[osteoporosis]] with [[calcium]] and [[vitamin D]] should be started with the [[steroid]] therapy. | The mainstay of treatment of polymyalgia rheumatica (PMR) is low dose [[glucocorticoids]], typically [[prednisone]] or [[prednisolone]]. The starting dose of the [[glucocorticoid]] treatment is 15-20 mg daily for 2 to 4 weeks after which the treatment should be slowly tapered. 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. Prophylaxis for [[osteoporosis]] with [[calcium]] and [[vitamin D]] should be started with the [[steroid]] therapy.<ref name="pmid23051717">{{cite journal| author=Kermani TA, Warrington KJ| title=Polymyalgia rheumatica. | journal=Lancet | year= 2013 | volume= 381 | issue= 9860 | pages= 63-72 | pmid=23051717 | doi=10.1016/S0140-6736(12)60680-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23051717 }} </ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
* The mainstay of treatment of PMR is low dose [[glucocorticoids]], typically [[prednisone]] or [[prednisolone]]: | * The mainstay of treatment of PMR is low dose [[glucocorticoids]], typically [[prednisone]] or [[prednisolone]]:<ref name="pmid23051717">{{cite journal| author=Kermani TA, Warrington KJ| title=Polymyalgia rheumatica. | journal=Lancet | year= 2013 | volume= 381 | issue= 9860 | pages= 63-72 | pmid=23051717 | doi=10.1016/S0140-6736(12)60680-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23051717 }} </ref> | ||
** The starting dose is 15-20 mg daily for 2 to 4 weeks | ** 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 | ** 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 | ** 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 arteritis]] | * 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 arteritis]].<ref name="pmid23051717">{{cite journal| author=Kermani TA, Warrington KJ| title=Polymyalgia rheumatica. | journal=Lancet | year= 2013 | volume= 381 | issue= 9860 | pages= 63-72 | pmid=23051717 | doi=10.1016/S0140-6736(12)60680-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23051717 }} </ref> | ||
* During the treatment, the subject's response to treatment should be monitored through: | * During the treatment, the subject's response to treatment should be monitored through: | ||
** Clinical symptoms | ** Clinical symptoms | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The mainstay of treatment of polymyalgia rheumatica (PMR) is low dose glucocorticoids, typically prednisone or prednisolone. The starting dose of the glucocorticoid treatment is 15-20 mg daily for 2 to 4 weeks after which the treatment should be slowly tapered. 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. Prophylaxis for osteoporosis with calcium and vitamin D should be started with the steroid therapy.[1]
Medical Therapy
- The mainstay of treatment of PMR is low dose glucocorticoids, typically prednisone or prednisolone:[1]
- 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 arteritis.[1]
- 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.[2]
- Infliximab use in PMR has not been proved beneficial and it may be harmful.[3]
- 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
- ↑ 1.0 1.1 1.2 Kermani TA, Warrington KJ (2013). "Polymyalgia rheumatica". Lancet. 381 (9860): 63–72. doi:10.1016/S0140-6736(12)60680-1. PMID 23051717.
- ↑ 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)