Treatments and drugs
Treatment usually involves medications to help ease your symptoms. Relapses are common.
Polymyalgia rheumatica is usually treated with a low dose of an oral corticosteroid, such as prednisone. A daily dose at the beginning of treatment is usually 12 to 25 milligrams a day.
You'll likely start to feel relief from pain and stiffness within the first two or three days. If you aren't responding to treatment, your doctor may refer you to a rheumatologist.
After the first two to four weeks of treatment, your doctor may begin to gradually decrease your dosage depending on your symptoms and the results of blood tests. The goal is to keep you on as low a dose as possible without triggering a relapse in your symptoms.
Most people with polymyalgia rheumatica need to continue the corticosteroid treatment for at least a year. You'll need frequent follow-up visits with your doctor to monitor how the treatment is working and whether you're having any side effects.
People who taper off the medication too quickly are more likely to have a relapse. Thirty to 60 percent of people with polymyalgia rheumatica will have at least one relapse when tapering off the corticosteroids. Relapses (flares) are treated by increasing your drug dosage for a while then tapering again.
Monitoring side effects
Long-term use of corticosteroids can result in a number of serious side effects. Your doctor will monitor you closely for problems. He or she may adjust your dosage and prescribe treatments to manage these reactions to corticosteroid treatment. Possible side effects include:
- Weight gain
- Osteoporosis — the loss of bone density and weakening of bones
- High blood pressure (hypertension)
- Cataracts — a clouding of the lenses of your eyes
Calcium and vitamin D supplements
Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent bone loss induced by corticosteroid treatment. The American Academy of Rheumatology recommends the following daily doses for anyone taking corticosteroids:
- 1,200 to 1,500 milligrams (mg) of calcium supplements
- 800 to 1,000 international units (IU) of vitamin D supplements
Your doctor may suggest you get a pneumonia vaccine if you are taking 20 milligrams or more of prednisone a day.
Joint guidelines from the American Academy of Rheumatology and the European League Against Rheumatism suggest using methotrexate with corticosteroids in some patients. This is an immune-suppressing medication that is taken by mouth. It may be useful early in the course of treatment or later, if you relapse or don't respond to corticosteroids.
You may benefit from physical therapy if you've had a long stretch of limited activity owing to polymyalgia rheumatica. Talk with your doctor about whether physical therapy is a good option for you if you're trying to regain strength, coordination and the ability to perform everyday tasks.