Polymyalgia Rheumatica Management Guidelines

Initial Assessment and Diagnosis

The European League Against Rheumatism recommends considering specialist referral for atypical presentations, such as peripheral inflammatory arthritis, systemic symptoms, low inflammatory markers, or age <60 years, as well as high risk of therapy-related side effects or PMR refractory to glucocorticoid therapy 3, 4
Determine comorbidities that may affect treatment decisions, particularly hypertension, diabetes, osteoporosis, glaucoma, cardiovascular disease, and peptic ulcer, as recommended by the European League Against Rheumatism 3, 4
Assess risk factors for relapse/prolonged therapy, including female sex, high ESR (>40 mm/hr), and peripheral inflammatory arthritis, according to the European League Against Rheumatism 3, 5

The European League Against Rheumatism recommends using glucocorticoids as first-line therapy rather than NSAIDs for PMR treatment, with an initial recommended dose of 12.5-25 mg prednisone equivalent daily 1, 2
Select initial prednisone dose within 12.5-25 mg/day range, with higher doses (closer to 25 mg) for patients with high relapse risk and low adverse event risk, and lower doses (closer to 12.5 mg) for patients with relevant comorbidities, as suggested by the European League Against Rheumatism 1, 2

The European League Against Rheumatism recommends initial tapering to reduce dose to 10 mg/day prednisone equivalent within 4-8 weeks, and once remission is achieved, taper daily prednisone by 1 mg every 4 weeks (or using alternate-day schedules) until discontinuation 1, 2

Schedule follow-up visits every 4-8 weeks in the first year, every 8-12 weeks in the second year, and as indicated for relapses or during tapering, as recommended by the European League Against Rheumatism 1, 2
Monitor for steroid-related side effects, disease activity and inflammatory markers (ESR, CRP), and comorbidities and risk factors for relapse, according to the European League Against Rheumatism 1, 3, 4

Provide education about PMR impact, treatment effects, comorbidities, and disease predictors, and advise on individually tailored exercise programs, as recommended by the European League Against Rheumatism 1, 3
Create an individualized PMR management plan with shared decision-making between patient and physician, according to the European League Against Rheumatism 3, 4