What treatments are there for polymyagia rheumatica (PMR)?

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Steroid tablets

Polymyalgia rheumatica (PMR) is treated with steroid tablets. They can have a powerful effect in reducing inflammation. They won’t cure PMR but your symptoms will probably improve significantly within a day or 2 once you start treatment. You’ll probably need to continue treatment for 2 years or more 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.

After a time your doctor will try to gradually reduce your dose to avoid potential side-effects, such as 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 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 while you’re taking steroid tablets and needs a period of time to resume normal production of natural steroids before the drug is stopped.

Steroids alert card

When taking steroid tablets you must carry a steroid card, which records your dose and how long you’ve been taking them. If you become ill, or are involved in an accident in which you’re injured or become unconscious, it’s important for the steroid to be continued. The dose might also need to be increased because the treatment may prevent your body from being able to produce enough natural steroids in response to stress, as normally happens in this situation. Your doctor, rheumatology nurse specialist or pharmacist can give you a steroid card.

Other treatments

Your doctor may suggest you take the following:

If your symptoms don’t improve with steroids, or if it’s difficult to reduce the dose over a period of time, your doctor may send you to see a specialist. The specialist may prescribe methotrexate tablets alongside the steroid tablets. Methotrexate reduces the activity of the immune system, which reduces inflammation.

It’s important to have regular check-ups and blood tests when you’re taking methotrexate so its effects can be monitored. It can cause side-effects such as:

  • feeling sick
  • mouth ulcers

More rarely it can cause more serious side-effects in the blood, liver or lungs. Most of these are picked up by the regular blood tests and get better if the drug is stopped.

Methotrexate is usually only given to people whose symptoms keep coming back. As the methotrexate takes effect it’s usually possible to reduce the dose of prednisolone.

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