Polymyalgia rheumatica medical therapy
|
Polymyalgia Rheumatica Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Polymyalgia rheumatica medical therapy On the Web |
|
American Roentgen Ray Society Images of Polymyalgia rheumatica medical therapy |
|
Risk calculators and risk factors for Polymyalgia rheumatica medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Anti-inflammatory medicine such as aspirin or ibuprofen is typically prescribed to treat mild cases of polymyalgia rheumatica. For more serious cases, with extreme pain and discomfort, steroids are prescribed to patients. Prednisone is the typical steroid used to treat polymyalgia rheumatica. The steroids are normally distributed in low doses (10-15 mg per day), and results are usually seen within the first few days of taking the medication.[1] The patient's SED rate is monitored throughout the medication process, and other blood tests are conducted to make sure the patient does not experience any side effects from the treatment. Once the SED rate is back to normal, the patient will receive lower doses of the steroids in order to avoid any long term health effects from the steroids.[2] Intramuscular methylprednisolone(40-120 mg)has similar effects like oral corticosteroids and the cumulative steroid dose is also less.[3]
Some side effects from the steroids may occur. 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.[2] Methylprednisolone has better side effect profile with respect to fracture rate and weight gain.[4] Prophylaxis for osteoporosis with calcium and vitamin D should be started along with steroid therapy.
Along with medical treatment, patients can increase their chances of recovery by exercising and eating healthy foods. Exercise will help strengthen the weak muscles, and help to prevent weight gain. A healthy diet will help to keep a strong immune system, and also help build strong muscles and bones.[2]
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.[5]
Acute Pharmacotherapies
- NSAIDs helpful in mild disease
- Glucocorticoids if no response to non-steriod anti inflammatory drugs (NSAIDs)
- Prednisone 5-20 mg every day--rapid improvement in symptoms
- Start taper after symptoms remit and ESR returns to normal (2-4 weeks)
- Gradual dose reduction (eg, by 2.5 mg) q 1-4 weeks until dose = 5-10 mg every day
- Even slower taper once dose < 5-10 mg (reduce dose by 1 mg q month)
- Monitor for relapse--occurs in 25-50%, usually because taper too rapid
- Careful observation for signs of arteritis
Other therapies
Glucocorticoids are the most effective medication for polymyalgia rheumatica. Other medications are considered in steroid resistant cases i.e no good response with 20mg/day prednisone, atypical cases and in patients at high risk for steroid related toxicity.
- Methotrexate is the commonly used steroid sparing agent.Prednisone plus methotrexate treatment is associated with shorter prednisone treatment.[6]
- Infliximab use in [[[PMR]] has not been proved beneficial and it may be harmful.[7]
- Etanercept may be safe and useful in relapsing PMR. It is modestly effective in PMR associated with giantcell arteritis than in isolated PMR.Trials are still in progress to determine the benefit and the differences in response.
EULAR response criteria for PMR comprise a set of core markers for monitoring therapeutic response which include :
- Visual analogue scale of patient's pain
- Ability to elevate the upper limbs.
A disease activity score <7 indicates low activity, 7-17 suggest medium disease activity, >17 indicates high disease activity.[8]
References
- ↑ http://www.rheumatology.org/public/factsheets/pmr_new2.asp "POLYMYALGIA RHEUMATICA." American College of Rheumatology. June 2006. American College of Rheumatology. 11 Mar. 2008
- ↑ 2.0 2.1 2.2 http://www.mayoclinic.com/health/polymyalgia-rheumatica/DS00441/DSECTION=1 "Polymyalgia Rhuematica." MayoClinic. 17 May 2006. 15 Mar. 2008
- ↑ Dasgupta B, Gray J, Fernandes L, Olliff C (1991). "Treatment of polymyalgia rheumatica with intramuscular injections of depot methylprednisolone". Ann. Rheum. Dis. 50 (12): 942–5. PMC 1004588. PMID 1768166. Unknown parameter
|month=ignored (help) - ↑ Li C, Dasgupta B (2000). "Corticosteroids in polymyalgia rheumatica--a review of different treatment schedules". Clin. Exp. Rheumatol. 18 (4 Suppl 20): S56–7. PMID 10948765.
- ↑ http://www.medicinenet.com/polymyalgia_rheumatica/page2.htm#6whatis Shiel, William C. MD, FACP, FACR. "Polymyalgia Rheumatica (PMR) & Giant Cell Arteritis (Temporal Arteritis)." MedicineNet. 3 Mar. 2008. 14 Mar. 2008
- ↑ 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) - ↑ Nothnagl T, Leeb BF (2006). "Diagnosis, differential diagnosis and treatment of polymyalgia rheumatica". Drugs Aging. 23 (5): 391–402. PMID 16823992.