What treatments are there for polymyagia rheumatica (PMR)?
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Standard painkillers or anti-inflammatory drugs alone aren't enough to ease the symptoms of PMR. However, steroid treatment is usually very effective.
Steroid tablets (corticosteroids) aren't the same as the steroids sometimes used by athletes and bodybuilders (which are known as anabolic steroids). Corticosteroids are similar to steroids produced naturally in the body, which play an important part in keeping you healthy.
Steroid treatment can have a powerful effect in reducing inflammation. They won’t cure PMR but the symptoms often improve significantly within about two weeks of starting treatment. The symptoms may have almost completely disappeared after four weeks. However, you’ll probably need to continue treatment for up to two years, and occasionally longer, to stop symptoms returning.
The steroid tablet most often prescribed is prednisolone. A starting dose of 15 mg a day usually makes symptoms disappear completely. If you have giant cell arteritis (GCA) you’ll need higher doses than this to begin with to protect your vision.
If you're at increased risk of side-effects from steroid tablets (for example, if you have diabetes, high blood pressure, a recent fracture, peptic ulcer, cataract or glaucoma) some doctors may suggest steroid injections (Depo-Medrone) into a muscle instead. Your doctor may also suggest bone protection treatment to reduce the risk of osteoporosis, which can be a problem with long-term steroid treatment.
After a time your doctor will try to gradually reduce your dose to avoid potential side-effects, such as weight gain and osteoporosis. This will be done in stages depending mainly on your symptoms but helped by repeat ESR or CRP test results. If your symptoms return when the dose is reduced your doctor may have to increase it for a short time. They’ll then try to reduce it again after several weeks. Raised ESR or CRP test results alone don’t necessarily mean your steroid dose needs to be increased.
Even when you feel well, your doctor may want to see you regularly so that they can check you for signs of a relapse or side-effects from the steroids. They may want to check your general health or ask you to have a bone density (DEXA) scan to assess the strength of your bones.
You shouldn’t stop taking your steroid tablets suddenly or alter the dose unless your doctor tells you, even if your symptoms have completely cleared up. This is because your body stops producing its own steroids (cortisol) while you’re taking steroid tablets and needs a period of time to resume normal production of natural steroids when the drug is stopped.
Steroids alert card
When taking steroid tablets you must carry a steroid card, which shows your current dose and how long you’ve been taking them. This will help if you need to see another doctor or healthcare professional, for example a dentist. Depending what additional treatment you need the steroid dose may need to be adjusted. Steroid cards are available from most pharmacies.
Prevention of osteoporosis – Steroid treatments can increase the risk of osteoporosis, which means you're more likely to break a bone in a fall. Your doctor will advise on drugs to help guard against osteoporosis, for example, bisphosphonates such as risedronate or alendronate.
Pain control – You may be advised to take painkillers (analgesics) or non-steroidal anti-inflammatory drugs (NSAIDs) to help ease pain and stiffness, along with your steroids.
Disease-modifying anti-rheumatic drugs (DMARDs) – If your symptoms don’t improve with steroids, or if it’s difficult to reduce the dose over a period of time, or if you get frequent flare-ups of your condition, your doctor may send you to see a specialist. The specialist may prescribe other drugs alongside the steroid tablets – for example, methotrexate or leflunomide. These drugs reduce the activity of the immune system, which in turn reduces inflammation, and may allow the steroid dose to be reduced without the symptoms flaring up.
It’s important to have regular check-ups, blood tests and blood pressure checks when you’re taking DMARDs to check for early signs of side-effects and to check how well the treatment is working for you.
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