POLYMYALGIA RHEUMATICA-MANAGEMENT

SUMMARY

1. PMR responds dramatically to low-dose prednisone (about 10-20 mg/day), although it must be slowly tapered, usually over 2-3 years for cure.

2. If the exam gives you an older patient with shoulder pain who improves dramatically overnight after 1-2 doses of pred­nisone, the diagnosis is PMR.

3. PMR may occasionally respond to NSAIDs, but risk for PMR turning into GCA is increased if inflammation is not controlled.

4. As with GCA, the ESR correlates with disease activity; so, follow it during treatment.

5. If there are any signs of GCA (e.g., visual changes, headache), you must reevaluate immediately, including temporal artery biopsy and an increase in the prednisone dose.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].