Management of Relapsing Polymyalgia Rheumatica

Treatment Principles

• The European League Against Rheumatism recommends a temporary increase in glucocorticoid dose followed by gradual reduction in patients with relapsing polymyalgia rheumatica 4
• For patients who relapse on 5 mg or less of prednisone, the recommended approach is to return to the previous dose that effectively controlled symptoms 5
• The reduction should then be slower than initially, with a decrease rate not exceeding 1 mg per month 6

Reduction Schedule after Relapse

• After re-establishing symptom control with a higher dose, gradually reduce prednisone over 4-8 weeks to the dose at which the relapse occurred 7
• Once remission is achieved, decrease prednisone by 1 mg every 4 weeks (or in alternating schemes like 10/7.5 mg every other day) 8

Considerations for Frequent Relapses

• For patients with multiple or prolonged relapses, consider adding methotrexate as a corticosteroid-sparing agent 9

Monitoring and Follow-up

• Closely monitor inflammatory markers (such as erythrocyte sedimentation rate and C-reactive protein) and clinical symptoms to assess treatment response 10
• Follow-up visits are recommended every 4-8 weeks during the first year of treatment 1
• Systematically evaluate corticosteroid-related adverse effects, comorbidities, and relapse risk factors 7

Special Considerations

• For persistent nighttime pain when reducing below 5 mg/day, consider splitting the daily dose 2