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Polymyalgia rheumatica - Management
Basis for recommendation

  • The recommendation regarding osteoporosis prophylaxis is based on published guidance from the Royal College of Physicians [RCP, 2002]. Prophylaxis may be required because corticosteroids can cause osteoporosis, especially if taken over long periods. Most people with polymyalgia rheumatica need to take corticosteroids for 1–3 years. Some people have a chronic-relapsing course and may need low doses of prednisolone for several years [Salvarani et al, 2008].
  • These recommendations are based on expert opinion in published guidelines [Michet and Matteson, 2008; Salvarani et al, 2008], and by published guidelines that are based on draft guidance from the British Society for Rheumatology [Dasgupta et al, 2007].
  • The dose of prednisolone should be reduced slowly because relapses are common and are more likely to occur if corticosteroids are reduced or withdrawn too quickly [Salvarani et al, 2008]. Rapid tapering of corticosteroids has been associated with longer duration of therapy [Dasgupta et al, 2007].
  • The suggested tapering schedule is that proposed by the British Society for Rheumatology Guidelines Group [Dasgupta et al, 2007]. The schedules suggested by CKS expert reviewers varied considerably and locally recommended schedules may vary from the one proposed.
  • 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.
  • Complications of long-term corticosteroid treatment are common and may occur in up to 60% of people [Kremers et al, 2005; Michet and Matteson, 2008]. Adverse effects include osteoporosis, avascular necrosis, infections, diabetes, hypertension, and cataracts [Michet and Matteson, 2008].
  • In 56% of people, the ESR returns to normal within 2 weeks, and in 76% of people within 5 weeks. CRP decreases more rapidly, with 67% normalizing in 2 weeks and 75% in 3 weeks [Andersson et al, 1986a; Leeb et al, 2003].

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