May 31, 2016
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Polymyalgia Rheumatica (cont.)

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What is the treatment for polymyalgia rheumatica?

The treatment of polymyalgia rheumatica is directed toward reducing inflammation. While some patients with mild symptoms can improve with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Motrin, Advil), most patients respond best to low doses of cortisone medications (steroid medications, such as prednisone or prednisolone). Not infrequently, a single day of cortisone medication eases many of the symptoms! In fact, the rapid, gratifying results with low dose cortisone medications is characteristic of polymyalgia rheumatica.

The dose of prednisone is gradually reduced while the doctor monitors the symptoms and normalization of the blood ESR. Reactivation of symptoms can require periodic adjustments in the prednisone dosage. Most patients are able to completely wean from prednisone within several years. Some patients require longer-term treatment. Occasionally, patients have recurrence years after the symptoms have resolved. The ideal prednisone dosing regimen continues to be sought by researchers.

What is the prognosis (outlook) for patients with polymyalgia rheumatica?

The outlook for patients with isolated polymyalgia rheumatica is ultimately very good. Polymyalgia rheumatica can occur in association with giant cell arteritis (see below), a potentially more serious condition. It can also occur, as mentioned above, in association with a cancer. The prognosis in this setting is based on the ability to cure the cancer. The polymyalgia rheumatica symptoms resolve with resolution of the cancer.

One of the keys to successful treatment of polymyalgia rheumatica is gradual, and not rapid, tapering of the medications. This can avoid unwanted flare-ups of the disease.

Because the medications prednisone and prednisolone are associated with potential bone toxicity, causing osteoporosis, patients should consider calcium and vitamin D supplementation. Bone mineral density testing should be performed in appropriate patients, and osteoporosis medications, such as estrogen, alendronate (Fosamax), and risedronate (Actonel) are considered.

Medically Reviewed by a Doctor on 3/7/2016


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