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Polymyalgia rheumatica - Management
Basis for recommendation

  • Unblinded, uncontrolled, prospective, and retrospective cohort studies suggest that corticosteroids are effective treatment for polymyalgia rheumatica. Corticosteroids have not been evaluated in placebo-controlled clinical trials, and it is unlikely these would ever take place because the effect of corticosteroids is so dramatic.
  • The initial dose of prednisolone of 15 mg each day is recommended by published guidelines that are based on draft guidance from the British Society for Rheumatology [Dasgupta et al, 2007].
  • Some experts recommend the use of intramuscular methylprednisolone in milder cases of polymyalgia rheumatica [Dasgupta et al, 2007]. However intramuscular methylprednisolone is not routinely used in primary care.
  • Rheumatology assessment is recommended in people with suspected polymyalgia rheumatica, because many features of the condition can lead to diagnostic error.
  • Among other assessments, a specialist may use a standardized scoring system to assess the response to corticosteroid treatment [Dasgupta et al, 2007; Michet and Matteson, 2008].
    • A diagnosis of polymyalgia rheumatica is likely if the person has a global response of greater than 70% improvement within 1 week and if inflammatory markers (ESR and CRP) return to normal in 3–4 weeks.
    • A lesser response may suggest that the cause of the symptoms is another condition, such as osteoarthritis, rheumatoid arthritis, cancer, or infection. Symptoms due to these conditions respond to corticosteroids, but the response is not as dramatic as that of polymyalgia rheumatica.
  • The diagnosis of polymyalgia rheumatica is not confirmed or sustained in up to 23% of people with suspected polymyalgia rheumatica when they are followed up [Dasgupta et al, 2007].
  • The recommendation that NSAIDs are not effective for treating polymyalgia rheumatica is based on published guidelines that are based on draft guidance from the British Society for Rheumatology [Dasgupta et al, 2007]. CKS found no trial evidence that NSAIDS were effective or not effective.

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