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Polymyalgia rheumatica - Management
What advice should I give someone with polymyalgia rheumatica?
- Advise the person:
- To seek urgent medical attention if they develop any visual disturbances.
- That the dose of prednisolone is normally reduced very slowly over several months. Treatment is often required for 1–2 years but some people may require low doses of corticosteroids for several years.
- That relapses may occur while taking prednisolone; they are more common when the dose is being reduced.
- That follow-up visits are required frequently in the initial phase of the condition to monitor for relapses and adverse effects of corticosteroids, then every few months as the condition stabilizes.
- Check the person has:
- A booklet on polymyalgia rheumatica and a contact for a regional patient support group if available (for example, see www.pmr-gca.org.uk).
- A blue steroid card, and discuss any potential adverse effects with them. For more information, see the CKS topic on Corticosteroids - oral.
- Give general and lifestyle recommendations to minimize adverse effects of corticosteroid treatment.
- Encourage adequate dietary calcium intake and good nutrition.
- Advise on maintaining a healthy body weight where possible.
- Advise on smoking cessation. See the CKS topic on Smoking cessation for more information.
- Advise on moderate alcohol consumption. See the CKS topic on Alcohol - problem drinking for more information.
- Encourage physical exercise.
- Perform a falls risk assessment, where appropriate, and advise those at increased risk of fractures from falling. See the CKS topic on Falls - risk assessment for more information.
- Advise the person that if they experience any adverse effects, they should not stop taking their prednisolone abruptly and that they should seek medical advice.
- Advise all people without a history of chickenpox or measles who are taking systemic prednisolone to avoid close contact with people who have chickenpox, shingles, or measles, and to seek urgent medical advice if they are exposed.
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