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Starting treatment for polymyalgia rheumatica

Issue 34 Synovium (Autumn 2011)

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Polymyalgia rheumatica (PMR) is one of the commonest inflammatory rheumatic disorders and is usually completely managed in primary care with oral prednisolone.

Guidelines suggest a starting dose of prednisolone of between 15 mg and 20 mg daily; however this is not based on much evidence from controlled trials evaluating the effects of different treatment doses. One trial showed that doses ≤10 mg were associated with a higher incidence of symptom recurrence and doses ≥20 mg with a higher incidence of adverse effects.

A new study1 followed 60 consecutive patients treated with 12.5 mg of oral prednisolone daily. This dose was found to be effective in controlling symptoms and normalising erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels in 47 of the 60 patients (78.3%) within 1 month. Interestingly, among a number of clinical parameters, low body weight best predicted a good response to the treatment. The mean dose of prednisolone per kilogram of body weight in responders was 0.19 mg (± 0.03) compared with 0.16 mg (± 0.03) in non-responders. This provides some evidence for calculating the starting dose of prednisolone.

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