Polymyalgia treatment without steroids

The value of glucocorticoids in the treatment of PMR has been established by decades of clinical experience and observational studies. Though we are not aware of any controlled trials comparing prednisone or prednisolone with placebo or other single agents, the brisk and dramatic therapeutic response to low-dose glucocorticoids remains a widely appreciated feature of PMR. Some patients with PMR may experience symptomatic improvement after only one or two doses of glucocorticoids, and the vast majority of such patients experience a marked improvement in symptoms within days of starting treatment, despite experiencing longstanding symptoms. Medications other than glucocorticoids, such as methotrexate (MTX) or tumor necrosis factor (TNF) inhibitors, have not conclusively been proven effective in PMR. Nonsteroidal antiinflammatory drugs (NSAIDs) have no role in the primary management of PMR.

PMR is very treatable. The only drug which is known to be a consistently effective therapy is  prednisone (or another corticosteroid of the same family), which works by decreasing inflammation. Methotrexate, a medication commonly used to treat rheumatoid arthritis and some other rheumatic diseases, has been used to reduce disease flares, but is not of certain benefit. Blood tests — including the erythrocyte sedimentation rate or C-reactive protein — will be done every few weeks to months to determine if the inflammation is still active. Most people require about 3 years of treatment, but duration varies widely.

O’Toole, . (Ed.) (2013). Polymyalgia rheumatica. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
Arthritis New Zealand (2012). Polymyalgia rheumatica (Pamphlet). Wellington: Arthritis New Zealand. http:///wp-content/uploads/2012/06/4618_Polymyalgia_Flyer_4-
Mayo Clinic (2017). Polymyalgia rheumatica (Web Page). Rochester: Mayo Foundation for Medical Education and Research. http:///diseases-conditions/polymyalgia-rheumatica/basics/definition/con-20023162 [Accessed: 12/01/17]
Nesher, G., Breuer, . Giant Cell Arteritis and Polymyalgia Rheumatica: 2016 Update. Rambam Maimonides Med J. 2016;7(4).
Saad, . (2016). Polymyalgia rheumatic treatment and management (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http:///article/330815-overview#a7 [Accessed: 13/01/17].

Last reviewed: January 2017

Polymyalgia rheumatica (PMR) is an inflammatory disorder typically seen in older adults that causes widespread aching, stiffness and flu-like symptoms. It is more common in women than men, and is seen more often in Caucasians than any other race. The average age of onset is 70 years, and it is rarely seen in people younger than 50. PMR is a self-limiting condition, lasting from one to five years; however, it varies from person to person. Approximately 15 percent of people with PMR develop a potentially dangerous condition called giant cell arteritis (also known as temporal arteritis ).

Polymyalgia treatment without steroids

polymyalgia treatment without steroids

Polymyalgia rheumatica (PMR) is an inflammatory disorder typically seen in older adults that causes widespread aching, stiffness and flu-like symptoms. It is more common in women than men, and is seen more often in Caucasians than any other race. The average age of onset is 70 years, and it is rarely seen in people younger than 50. PMR is a self-limiting condition, lasting from one to five years; however, it varies from person to person. Approximately 15 percent of people with PMR develop a potentially dangerous condition called giant cell arteritis (also known as temporal arteritis ).

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