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Polymyalgia rheumatica - Management
What initial management is required for someone with polymyalgia rheumatica?
If the person has symptoms or signs suggestive of giant cell arteritis, see the CKS topic on Giant cell arteritis. Visual symptoms need urgent (same day) referral.
- Establish a baseline against which to assess response to treatment by documenting:
- Current symptoms and signs of polymyalgia rheumatica.
- Symptoms or disability present before the onset of the current problem.
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
- Prescribe prednisolone 15 mg each day. Seek specialist advice if the person is unable to take oral prednisolone.
- Within 1 week, assess the person's response to prednisolone (symptoms should dramatically resolve within a few days).
- Consider early referral for people with atypical features and treatment dilemmas.
- Consider referring all people with suspected polymyalgia rheumatica to rheumatology for confirmation of the diagnosis (corticosteroids can be started while the person is awaiting specialist assessment).
- Ensure that the person understands the importance of new headaches, visual disturbances, and other symptoms and signs of giant cell arteritis and the need for urgent medical review if these develop.
- Do not prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) as these are not thought to be effective for polymyalgia rheumatica.
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