Diagnosis
-H&P
-ESR, CRP
–Prednisone 15mg po daily (max 20-30 mg/day) with a slow taper over 1-2 years.
-A response to treatment with prednisone would help to confirm the diagnosis of PMR. “The hallmark of this condition is the rapid and often dramatic response, typically within a few days, to low-dose corticosteroids. In fact, the lack of response to low-dose prednisone in such a case should prompt the physician to consider another diagnosis.”
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**Incidence increases with age but PMR is almost never seen before age 50.
**Methylprednisolone 120 mg IM every 3 weeks is an alternative treatment to the daily prednisone 15mg.
“Steroids are the mainstay of treatment with a starting dose of 15 mg/ d (maximum 20– 30 mg/ d) of prednisone or equivalent. The response to treatment is dramatic and is often seen within 24– 48 h & continued improvement will be seen over subsequent wks. If this dramatic response is not seen, you must consider an alternative dx (e.g., vasculitis).
Higher doses of steroids may be used to treat flares.
Check BMD, A1c, lipids, PPD (if risk factors present) for pts on long-term steroids to screen for glucocorticoid-related osteoporosis, DM2
Duration of steroid tx: Steroid treatment often continues for 2– 3 y with slow taper guided by inflammatory markers (ESR, CRP, ± IL-6) and patient’s symptoms.
Maintenance dose is typically 2.5– 5 mg/d prednisone; 50% of patients relapse
Steroid-sparing agents: Trials, case-series, & reports describe successful use of MTX, leflunomide, tocilizumab (Arthritis Care Res 2012), & TNF-α blockade
**NSAIDs: NSAIDs are not useful in the mgt of PMR and, in fact, are associated with high drug morbidity.” The ABFM
Reference
Am Fam Physician 2013;88(10):676-684