Polymyalgia Rheumatica (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
In this Article
- Polymyalgia rheumatica and giant cell arteritis facts
- What is polymyalgia rheumatica?
- What causes polymyalgia rheumatica?
- What are symptoms and signs of polymyalgia rheumatica?
- How is polymyalgia rheumatica diagnosed?
- What is the treatment for polymyalgia rheumatica?
- What is the prognosis (outlook) for patients with polymyalgia rheumatica?
- Can polymyalgia be prevented?
- What are complications of polymyalgia rheumatica?
- What is giant cell arteritis?
- What causes giant cell arteritis?
- What are symptoms of giant cell arteritis?
- How is giant cell arteritis diagnosed?
- What is the treatment for giant cell arteritis?
- What is the prognosis for patients with giant cell arteritis?
- Can giant cell arteritis be prevented?
- What are complications of giant cell arteritis?
- Find a local Rheumatologist in your town
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.
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