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Polymyalgia rheumatica - Management
What ongoing management is required for someone with polymyalgia rheumatica?

  • If the symptoms of polymyalgia rheumatica are controlled, reduce the dose of prednisolone slowly.
  • The dose may have to be titrated individually in each person with either smaller reductions or longer periods at each level (treatment duration may range from 1 year to 3 years).
    • A suggested schedule is to:
      • Continue prednisolone 15 mg each day until symptoms have returned to normal (usually 3 weeks), then
      • Reduce the dose to 12.5 mg each day for 3 weeks, then
      • Reduce the dose to 10 mg each day for 4–6 weeks, then
      • Reduce the dose by 1 mg every 4–8 weeks until treatment is stopped.
    • A week after any change in dose, review the person to exclude any relapse of symptoms. It may be possible to do this by telephone.
    • If symptoms worsen following a dose reduction, treat with the previous higher dose. For more information on how to manage relapses, see Managing relapses.
  • Start osteoporosis prophylaxis if the person is 65 years of age or older, or has a history of fragility fracture.
    • In other individuals, measure bone mineral density using dual energy X-ray absorptiometry (DXA) to assess fracture risk. If the T score is –1.5 or lower, consider prophylaxis.
    • For more information, see the CKS topic on Osteoporosis - preventing steroid-induced.
  • Monitor the person regularly to assess for disease relapse (including symptoms of giant cell arteritis, see the CKS topic on Giant cell arteritis) and steroid-related adverse effects.
  • Do not prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) as these are not effective.

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