Has there been a change in the treatment of polymyalgia rheumatic (PMR)?
Q) Has there been a change in the treatment of polymyalgia rheumatica (PMR)? I was diagnosed with this condition in 2001 and prescribed 30 mg of steroids. This was reduced very slowly. Later I was again put on 30 mg of steroids. A friend was diagnosed with the condition some six weeks ago and was prescribed 20 mg of steroids and is now on 9.5 mg. She doesn't need to see her GP for blood tests as I did, and has been given a timetable to reduce the dose herself. My friend has had no weight gain, whereas I put on two and a half stone! I feel there must have been a radical rethink on the part of the medical profession. Is this so?
Jean Bullmore, Luton, Bedfordshire (Autumn 2008)
A) Yes, I think you're largely correct. Your friend has been given the recommended treatment for PMR – a starting dose of prednisolone of 20 mg with gradual tapering to a dose which just controls the symptoms. This dose is then maintained for 12–18 months before the steroids are withdrawn. People on long-term steroids (and 12–18 months is long-term) should have supplements of calcium and vitamin D to help prevent thinning of the bones. In some people additional treatment with bisphosphonates (such as alendronate and risedronate) is given, particularly if they already have risk factors for thin bones.