Management of Polymyalgia Rheumatica
Treatment Duration and Tapering
- The European League Against Rheumatism recommends that after achieving remission, glucocorticoids are gradually tapered by approximately 1 mg every 4 weeks until discontinuation 1
- Follow-up visits are recommended every 4-8 weeks during the first year and every 8-12 weeks in the second year of treatment 1
Factors Affecting Disease Duration
- Female sex is associated with longer treatment duration and higher risk of glucocorticoid-related adverse events 2
- The presence of peripheral arthritis may be associated with higher relapse rates and prolonged therapy 2
- High erythrocyte sedimentation rate (>40 mm/1st hour) may influence treatment duration and relapse risk 1
Relapse Management
- For relapse therapy, the glucocorticoid dose should be increased to the previously effective (pre-relapse) dose 1
- After relapse control, the dose should be decreased gradually within 4-8 weeks to the dose at which the relapse occurred 1
Disease-Modifying Antirheumatic Drugs
- Methotrexate (7.5-10 mg/week) may be considered as a glucocorticoid-sparing agent for patients with multiple or prolonged relapses 1
- Early introduction of methotrexate is conditionally recommended for patients at high risk of relapse or prolonged therapy 1