Polimialgia reumatyczna – Zapobieganie i profilaktyka

Polimialgia reumatyczna
Zapobieganie i profilaktyka

Polimialgia reumatyczna (PMR) to zapalna choroba mięśni i stawów proksymalnych, dotykająca głównie osoby powyżej 50. roku życia. Wczesne rozpoznanie i odpowiednia diagnostyka, w tym monitorowanie markerów zapalnych (OB, CRP), są kluczowe dla skutecznej profilaktyki powikłań. Leczenie opiera się na glikokortykosteroidach, jednak ze względu na ryzyko działań niepożądanych, zaleca się suplementację wapnia (1000-1200 mg/dzień) i witaminy D (do 1000 IU/dzień) od początku terapii oraz wykonanie badania gęstości mineralnej kości (DEXA). U pacjentów wysokiego ryzyka (wiek >65 lat, złamania niskoenergetyczne) wskazane jest stosowanie bisfosfonianów (alendronian, risedronian) w celu zapobiegania osteoporozie. Dodatkowo, profilaktyka powikłań żołądkowo-jelitowych obejmuje stosowanie inhibitorów pompy protonowej, a szczepienia przeciwko pneumokokom i grypie powinny być wykonane przed rozpoczęciem terapii steroidami.

Profilaktyka polimialgia reumatyczna

Wczesne rozpoznanie i diagnostyka
Profilaktyka powikłań glikokortykosteroidów
Aktywność fizyczna i rehabilitacja
Dieta i styl życia
Monitorowanie i zapobieganie nawrotom
Nowe strategie profilaktyczne
Ocena ryzyka upadków

Podsumowanie profilaktyki PMR

Kolejne rozdziały

Profilaktyka polimialgia reumatyczna

Polimialgia reumatyczna (PMR) jest chorobą zapalną, która głównie dotyka mięśnie i stawy proksymalne, powodując niepełnosprawność u osób starszych. Obecnie nie istnieje znany sposób zapobiegania rozwojowi samej polimialgi reumatycznej, ponieważ dokładna przyczyna choroby nie została jeszcze poznana.¹²³ Strategie profilaktyczne koncentrują się głównie na zapobieganiu powikłaniom związanym z leczeniem oraz wczesnym rozpoznaniu choroby.

Wczesne rozpoznanie i diagnostyka

Wczesne rozpoznanie i odpowiednia diagnoza są kluczowymi elementami w profilaktyce PMR. Ponieważ choroba ta występuje głównie u osób powyżej 50. roku życia, proaktywne badania przesiewowe i kampanie informacyjne w tej grupie wiekowej mogą ułatwić wczesną identyfikację objawów, umożliwiając szybką interwencję medyczną.⁴ Podwyższenie świadomości wśród pracowników ochrony zdrowia na temat cech klinicznych i kryteriów diagnostycznych PMR może poprawić wskaźniki wykrywalności. Regularne monitorowanie markerów zapalnych, takich jak OB i CRP, u starszych osób z dolegliwościami mięśniowo-szkieletowymi może pomóc we wczesnym wykryciu choroby.⁵

Profilaktyka powikłań glikokortykosteroidów

Główną metodą leczenia polimialgi reumatycznej są glikokortykosteroidy, jednak ich długotrwałe stosowanie wiąże się z licznymi działaniami niepożądanymi. Kluczowe jest zatem podejmowanie działań zapobiegawczych w celu minimalizacji tych powikłań.⁶⁷

Zapobieganie osteoporozie

Wszyscy pacjenci rozpoczynający długotrwałą terapię glikokortykosteroidami z powodu PMR powinni otrzymać suplementację wapnia (1000-1200 mg dziennie) i witaminy D (do 1000 IU dziennie).⁸⁹ Suplementacja ta powinna być wdrożona od początku leczenia steroidami, aby zapobiec utracie masy kostnej. Przed rozpoczęciem terapii zaleca się wykonanie badania gęstości mineralnej kości (np. badania DEXA).¹⁰

U pacjentów wysokiego ryzyka (osoby powyżej 65 roku życia, z przebytymi złamaniami niskoenergetycznymi) należy rozważyć włączenie leków przeciwosteoporotycznych, takich jak bisfosfoniany.¹¹ Badania wykazały, że stosowanie bisfosfonianów, szczególnie alendronianu (Fosamax) i risedronianu (Actonel), może zwiększyć gęstość mineralną kości i zmniejszyć ryzyko złamań kręgów u pacjentów poddanych długotrwałej terapii glikokortykosteroidami.¹²¹³

Profilaktyka owrzodzeń żołądkowo-jelitowych

U pacjentów stosujących długotrwale glikokortykosteroidy należy rozważyć włączenie leków zmniejszających ryzyko powikłań żołądkowo-jelitowych, takich jak inhibitory pompy protonowej.¹⁴

Szczepienia ochronne

Zaleca się wykonanie odpowiednich szczepień ochronnych, najlepiej przed rozpoczęciem terapii glikokortykosteroidami. Szczególnie istotne są szczepienia przeciwko pneumokokom i grypie.¹⁵¹⁶

Aktywność fizyczna i rehabilitacja

Regularna aktywność fizyczna jest istotnym elementem zapobiegania powikłaniom PMR i skutkom ubocznym leczenia. Wytyczne European League Against Rheumatism/American College of Rheumatology zalecają rozważenie zindywidualizowanego programu ćwiczeń dla pacjentów z PMR, mającego na celu utrzymanie masy i funkcji mięśni oraz zmniejszenie ryzyka upadków, szczególnie u starszych pacjentów poddanych długotrwałej terapii glikokortykosteroidami oraz u pacjentów osłabionych.¹⁷¹⁸

Program ćwiczeń wzmacniających kości powinien obejmować cztery główne komponenty:¹⁹

Ćwiczenia z obciążeniem, takie jak chodzenie, wchodzenie po schodach, gra w tenisa i taniec, które zmuszają organizm do pracy przeciwko grawitacji, co pomaga wzmocnić kości
Ćwiczenia wytrzymałościowe i oporowe
Ćwiczenia równoważne i poprawiające koordynację
Ćwiczenia rozciągające poprawiające zakres ruchu

²⁰

Pacjenci z PMR muszą znaleźć odpowiednią równowagę między odpoczynkiem a aktywnością. Zbyt intensywne ćwiczenia mogą nasilić objawy, ale umiarkowana aktywność pomaga złagodzić ból i sztywność mięśni barków, bioder i ud.²¹ Odpowiednie formy aktywności to jazda na rowerze stacjonarnym, pływanie i spacery.²²

W ramach kompleksowej opieki nad pacjentem warto rozważyć skierowanie na fizjoterapię. Fizjoterapeuta może nauczyć ćwiczeń pomagających utrzymać masę mięśniową oraz poprawić zakres ruchu w stawach, które są trudne do poruszania.²³²⁴

Dieta i styl życia

Edukacja pacjentów na temat czynników stylu życia, które mogą wpływać na stany zapalne, oraz promowanie regularnej aktywności fizycznej i zdrowej diety może odgrywać rolę w zapobieganiu lub łagodzeniu ciężkości PMR.²⁵

Zalecenia dietetyczne dla pacjentów z PMR obejmują:²⁶

Spożywanie kwasów tłuszczowych omega-3, które mogą pomóc odwrócić odpowiedź układu odpornościowego na stan zapalny i chronić przed nawrotem PMR
Odpowiednie spożycie wapnia (700-1200 mg dziennie) i witaminy D, które są szczególnie ważne podczas leczenia steroidami
Unikanie pokarmów mogących nasilać stany zapalne (np. produktów pełnotłuszczowych, niektórych produktów pszenicznych)

²⁷²⁸²⁹

Niektórzy pacjenci zgłaszają, że stosując dietę paleo lub bezglutenową w połączeniu z ćwiczeniami, byli w stanie kontrolować swoje objawy i odstawić steroidy w okresie do 1 roku.³⁰ Należy jednak pamiętać, że zmiany dietetyczne i suplementy nie są szybkimi rozwiązaniami ani samodzielnymi metodami leczenia PMR.³¹

Dodatkowe zalecenia dotyczące stylu życia obejmują:³²³³

Unikanie palenia tytoniu – palenie nie tylko szkodzi ogólnemu zdrowiu, ale może także nasilać objawy PMR i utrudniać leczenie
Odpowiednie rozplanowanie aktywności, aby maksymalnie wykorzystać energię
Korzystanie z urządzeń wspomagających w razie potrzeby (np. podwyższone siedzenia toaletowe, laski, chodziki) w celu utrzymania równowagi i ułatwienia codziennych czynności
Dołączenie do grupy wsparcia, aby uniknąć izolacji związanej z chorobą przewlekłą

³⁴³⁵

Monitorowanie i zapobieganie nawrotom

Nawroty PMR występują u około 50% pacjentów, najczęściej w ciągu pierwszych 18 miesięcy terapii oraz w ciągu roku od odstawienia glikokortykosteroidów.³⁶ Wszyscy pacjenci powinni być regularnie monitorowani pod kątem objawów nawrotu podczas zmniejszania dawki steroidów i przez 12 miesięcy po zakończeniu terapii.³⁷

Aby pomóc uniknąć nawrotów, terapia powinna być kontynuowana do ustąpienia objawów, a następnie dawki leków powinny być powoli zmniejszane.³⁸ Dawka glikokortykosteroidu, która kontroluje objawy, jest zwykle utrzymywana przez 2-4 tygodnie po ustąpieniu bólu i sztywności. Następnie dawka jest zmniejszana o około 20% co 2-4 tygodnie, w zależności od tolerancji, do minimalnej ilości potrzebnej do utrzymania supresji objawów.³⁹

Po wystąpieniu 2 nawrotów można rozważyć zastosowanie leków oszczędzających steroidy, takich jak metotreksat, azatiopryna, inhibitor TNF lub bloker receptora interleukiny 6 (IL-6).⁴⁰ Wytyczne EULAR/ACR zalecają wczesne wprowadzenie terapii metotreksatem w połączeniu z glikokortykosteroidami u pacjentów z wysokim ryzykiem nawrotu lub długotrwałej terapii oraz u tych, u których wystąpiły działania niepożądane związane z glikokortykosteroidami.⁴¹

Kategoria profilaktyki	Zalecenia	Uwagi
Profilaktyka osteoporozy	– Wapń (1000-1200 mg/dzień) – Witamina D (do 1000 IU/dzień) – Bisfosfoniany u pacjentów wysokiego ryzyka	Rozpocząć na początku terapii steroidami, monitorować BMD
Profilaktyka żołądkowo-jelitowa	Inhibitory pompy protonowej	Zapobieganie owrzodzeniom żołądka i dwunastnicy
Szczepienia	– Przeciwko pneumokokom – Przeciwko grypie	Najlepiej przed rozpoczęciem terapii steroidami
Aktywność fizyczna	– Ćwiczenia z obciążeniem – Ćwiczenia oporowe – Ćwiczenia równoważne – Ćwiczenia rozciągające	Dostosowane do indywidualnych możliwości pacjenta
Modyfikacje stylu życia	– Zdrowa dieta – Unikanie palenia – Odpowiedni odpoczynek – Unikanie stresu	Wskazane wsparcie psychologiczne i edukacja pacjenta
Zapobieganie nawrotom	– Regularne monitorowanie – Powolne zmniejszanie dawki steroidów – Leki oszczędzające steroidy w wybranych przypadkach	Szczególna uwaga w pierwszych 18 miesiącach i przez rok po odstawieniu steroidów

Nowe strategie profilaktyczne

Istnieje duża potrzeba opracowania alternatyw dla glikokortykosteroidów w leczeniu PMR. Obecnie jednak nie ma alternatywnego leku, który byłby poparty dobrymi dowodami i byłby przystępny cenowo.⁴² Leki oszczędzające steroidy, takie jak metotreksat, nie są obecnie zalecane do rozpoczęcia wkrótce po diagnozie, jak ma to miejsce w przypadku reumatoidalnego zapalenia stawów.⁴³

Obiecującą opcją oszczędzającą glikokortykosteroidy są inhibitory IL-6, w szczególności tocilizumab i sarilumab.⁴⁴ Stosowanie tych leków wiązało się z szybką poprawą bólu i sztywności u pacjentów z PMR. Dodatkowo, leki te ułatwiają zmniejszenie skumulowanej dawki glikokortykosteroidów, obniżając tym samym ryzyko działań niepożądanych związanych z długotrwałą terapią glikokortykosteroidami.⁴⁵

Jedynym lekiem biologicznym zatwierdzonym przez FDA specjalnie do leczenia PMR jest sarilumab, który jest podawany podskórnie co dwa tygodnie. Ten lek biologiczny ma korzystny profil bezpieczeństwa i może zapewnić trwałą remisję, co czyni go szczególnie korzystnym dla pacjentów, którzy mają trudności z utrzymaniem remisji choroby przy tradycyjnych terapiach.⁴⁶

Potrzebne są dalsze badania nad mechanizmami leżącymi u podstaw uszkodzeń związanych z glikokortykosteroidami w PMR. Istnieje również potrzeba znalezienia sposobów przewidywania, którzy pacjenci prawdopodobnie będą wymagać długotrwałego stosowania glikokortykosteroidów, oraz opracowania pragmatycznego podejścia terapeutycznego dla nich.⁴⁷

Ocena ryzyka upadków

Wiele osób z polimialgia reumatyczną może odnieść korzyści z oceny ryzyka upadków w momencie diagnozy i regularnych przeglądów leczenia.⁴⁸ Badania podkreślają znaczenie oceny ryzyka upadków u osób z PMR przy najwcześniejszej możliwej okazji. Daje to osobom z wysokim ryzykiem możliwość przyjmowania leków chroniących kości. Mogą również skorzystać z interwencji zapobiegających upadkom.⁴⁹

Pacjenci powinni mieć ocenę ryzyka upadków. Więcej niż 2 upadki rocznie są czynnikiem ryzyka złamania i zwiększają wynik oceny FRAX.⁵⁰

Podsumowanie profilaktyki PMR

Chociaż nie można zapobiec rozwojowi polimialgi reumatycznej, można podjąć szereg działań profilaktycznych w celu zapobiegania powikłaniom związanym z chorobą i jej leczeniem. Wieloaspektowe podejście łączące świadomość społeczną, edukację pracowników ochrony zdrowia i proaktywne badania przesiewowe daje nadzieję na poprawę wysiłków w zakresie odstraszania i zapobiegania wpływowi PMR.⁵¹

Kluczowe elementy profilaktyki obejmują:⁵²

Wczesne rozpoznanie i odpowiednie leczenie
Suplementację wapnia i witaminy D w celu zapobiegania utracie masy kostnej
Rozważenie bisfosfonianów u pacjentów wysokiego ryzyka
Szczepienia przeciwko pneumokokom i grypie
Regularną aktywność fizyczną dostosowaną do możliwości pacjenta
Zdrową dietę i unikanie pokarmów nasilających stan zapalny
Regularne monitorowanie w celu wczesnego wykrycia nawrotów lub rozwoju olbrzymiokomórkowego zapalenia tętnic
Rozważenie leków oszczędzających steroidy w wybranych przypadkach

⁵³

Rokowanie dla osób z polimialgia reumatyczną jest doskonałe, pod warunkiem odpowiedniego leczenia i monitorowania.⁵⁴ Wiele osób z PMR może zakończyć leczenie po roku lub dwóch i pozostać bez objawów, ale inni mogą potrzebować dożywotniego leczenia, aby zapobiec nawrotom.⁵⁵

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Materiały źródłowe

#1 Polymyalgia Rheumatica: Causes, Symptoms, Diagnosis, Treatment, Medications
https://www.medicinenet.com/polymyalgia_rheumatica/article.htm
Is it possible to prevent polymyalgia rheumatica? There is no prevention for polymyalgia rheumatica. Prevention measures focus on preventing side effects of drugs used to treat polymyalgia rheumatica.
#2 Polymyalgia rheumatica: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/000415.htm
There is no known prevention.
#3 Polymyalgia Rheumatica – Harvard Health
https://www.health.harvard.edu/a_to_z/polymyalgia-rheumatica-a-to-z
There is no known way to prevent polymyalgia rheumatica. […] Treatment may be required for years. But the outlook for people with polymyalgia rheumatica is excellent. […] However, effective therapy is available to prevent these complications.
#4 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537274/
Deterrence and prevention strategies for PMR primarily revolve around early recognition, accurate diagnosis, and timely initiation of appropriate treatment. […] Since PMR predominantly affects individuals older than 50 years, proactive screening and awareness campaigns among this age group may facilitate early identification of symptoms, enabling prompt medical intervention. […] Additionally, raising awareness among healthcare professionals about the clinical features and diagnostic criteria for PMR can improve detection rates. […] Implementing routine monitoring of inflammatory markers, such as ESR and CRP, in older populations with musculoskeletal complaints can aid in early detection. […] Moreover, educating the public on lifestyle factors that may impact inflammatory conditions and promoting regular physical activity and a healthy diet may play a role in preventing or mitigating the severity of PMR. […] Overall, a multifaceted approach that combines public awareness, healthcare provider education, and proactive screening holds promise for enhancing deterrence and prevention efforts against the impact of PMR.
#5 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537274/
Deterrence and prevention strategies for PMR primarily revolve around early recognition, accurate diagnosis, and timely initiation of appropriate treatment. […] Since PMR predominantly affects individuals older than 50 years, proactive screening and awareness campaigns among this age group may facilitate early identification of symptoms, enabling prompt medical intervention. […] Additionally, raising awareness among healthcare professionals about the clinical features and diagnostic criteria for PMR can improve detection rates. […] Implementing routine monitoring of inflammatory markers, such as ESR and CRP, in older populations with musculoskeletal complaints can aid in early detection. […] Moreover, educating the public on lifestyle factors that may impact inflammatory conditions and promoting regular physical activity and a healthy diet may play a role in preventing or mitigating the severity of PMR. […] Overall, a multifaceted approach that combines public awareness, healthcare provider education, and proactive screening holds promise for enhancing deterrence and prevention efforts against the impact of PMR.
#6 Traditional and Emerging Strategies for Managing Polymyalgia Rheumatica: Insights into New Treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC11546695/
Glucocorticoids are the primary treatment for isolated PMR but are associated with comorbidities, especially in patients with pre-existing conditions or frequent relapses. […] Glucocorticoid-sparing agents, such as methotrexate and biologics, in particular tocilizumab and sarilumab, offer alternatives, improving symptoms and reducing glucocorticoid use. […] While biologic agents reduce long-term side effects and help achieve disease remission, their use must consider potential side effects and higher costs compared to traditional therapies. […] The 2015 EULAR/ACR guidelines recommend considering early methotrexate use for patients at high risk of relapses or those facing prolonged therapy, especially if they have comorbidities or are on other medications that increase the likelihood of glucocorticoid side effects.
#7 Polymyalgia Rheumatica | Arthritis Foundation
https://www.arthritis.org/diseases/polymyalgia-rheumatica
Many people with PMR can stop medication after a year or two and remain symptom-free, but others may need life-long treatment to prevent relapses. […] To minimize risks associated with treatment: Be sure you fully understand the risks and benefits of corticosteroids. Mild PMR sometimes goes away on its own, so discuss this possibility with your health care provider. […] While taking a corticosteroid drug, you should be closely monitored for side effects. Be aware of changes and report them immediately to your doctor. […] Ask your doctor about taking calcium and vitamin D supplements while you’re on steroids to help prevent bone loss and reduce the risk of fractures. Some people lose 10% to 20% of their bone mass in the first six months of corticosteroid therapy. […] Get plenty of regular exercise to preserve strength and flexibility and counter some of the side effects of treatment. […] Emphasize a healthy, anti-inflammatory diet and restorative sleep. […] Corticosteroids can affect your memory and mood; know how to counter these problems with deep breathing, meditation or other healthy stress relievers that work for you.
#8 Polymyalgia Rheumatica: A Severe, Self-Limiting Disease
https://www.uspharmacist.com/article/polymyalgia-rheumatica-a-severe-self-limiting-disease
While there have been no major studies on the relationship between inflammatory foods (e.g., wheat products) and PMR, many patients have reported that by following a paleo or gluten-free diet and exercising, they have been able to control their symptoms and taper off the steroids in a period of up to 1 year. […] To prevent osteopenia or osteoporosis during the treatment, supplementation with calcium (1,000-1,200 mg/day) and vitamin D (up to 1,000 IU/day) should be initiated in all patients with PMR who are starting corticosteroid therapy. […] Because relapses are more likely to occur during the initial 18 months of therapy and within 1 year of corticosteroid withdrawal, all patients should be monitored for symptom recurrence throughout corticosteroid tapering and until 12 months after cessation of therapy.
#9 Polymyalgia Rheumatica (PMR) Treatment & Management: Approach Considerations, Diet and Activity, Consultations and Long-Term Monitoring
https://emedicine.medscape.com/article/330815-treatment
Calcium and vitamin D supplementation should be initiated in all patients with PMR who are starting corticosteroid therapy. […] European League Against Rheumatism/American College of Rheumatology collaborative guidelines conditionally recommend consideration of an individualized exercise program for patients with PMR, with the goals of maintaining muscle mass and function and reducing risk of falls, especially in older patients on long-term corticosteroids as well as frail patients. […] Appropriate immunizations should be administered, ideally before corticosteroid therapy is initiated. […] A baseline bone mineral density study (eg, dual-energy x-ray absorptiometry [DEXA] scan) is recommended at the onset of treatment. As most patients require corticosteroids for at least 1-2 years, bisphosphonate therapy is recommended to prevent corticosteroid-induced osteoporosis.
#10 Polymyalgia Rheumatica (PMR) Treatment & Management: Approach Considerations, Diet and Activity, Consultations and Long-Term Monitoring
https://emedicine.medscape.com/article/330815-treatment
Calcium and vitamin D supplementation should be initiated in all patients with PMR who are starting corticosteroid therapy. […] European League Against Rheumatism/American College of Rheumatology collaborative guidelines conditionally recommend consideration of an individualized exercise program for patients with PMR, with the goals of maintaining muscle mass and function and reducing risk of falls, especially in older patients on long-term corticosteroids as well as frail patients. […] Appropriate immunizations should be administered, ideally before corticosteroid therapy is initiated. […] A baseline bone mineral density study (eg, dual-energy x-ray absorptiometry [DEXA] scan) is recommended at the onset of treatment. As most patients require corticosteroids for at least 1-2 years, bisphosphonate therapy is recommended to prevent corticosteroid-induced osteoporosis.
#11 Polymyalgia rheumatica: treatment reviews are needed – NIHR Evidence
https://evidence.nihr.ac.uk/alert/polymyalgia-rheumatica-treatment-reviews-and-falls-assessment/
Many people with polymyalgia rheumatica would benefit from a falls assessment when first diagnosed, and regular treatment reviews. […] To prevent fractures, people with polymyalgia rheumatica should also take calcium and vitamin D supplements to strengthen bones. […] Those at particularly high risk of fractures (people over 65, those who have had a fragility fracture) should also take osteoporosis treatments (such as bisphosphonates). […] This research emphasises the importance of assessing people with polymyalgia rheumatica for falls at the earliest opportunity. This gives those at high risk the opportunity to take medicines to protect bones. They may also benefit from interventions to prevent falls. […] Patients should have a falls risk assessment. More than 2 falls a year is a risk factor for fracture and increases the FRAX assessment result.
#12 Recognition and Management of Polymyalgia Rheumatica and Giant Cell Arteritis | AAFP
https://www.aafp.org/pubs/afp/issues/2013/1115/p676.html
Polymyalgia rheumatica primarily affects proximal muscles and joints, causing disability in older adults. […] Osteoporosis management and gastrointestinal ulcer prophylaxis should be initiated. […] Medications should be instituted to decrease fracture risk in patients on high-dose, long-term glucocorticoid therapy. […] Low-dose aspirin should be used as an adjunctive treatment to decrease the risk of ischemic events in patients with giant cell arteritis. […] Recommendations that address long-term corticosteroid complications are listed in Table 3. […] Studies show that use of bisphosphonates, specifically alendronate (Fosamax) and risedronate (Actonel), can increase bone mineral density and decrease vertebral fractures in patients on long-term glucocorticoid therapy. […] All patients should be monitored for long-term complications of high-dose corticosteroid use. […] Medications that protect patients from osteoporosis (such as bisphosphonates) and gastrointestinal ulcers (such as proton pump inhibitors) should be initiated. […] Immunization against pneumococcus and influenza is also necessary.
#13 Recognition and Management of Polymyalgia Rheumatica and Giant Cell Arteritis | AAFP
https://www.aafp.org/pubs/afp/issues/2013/1115/p676.html/1000
Polymyalgia rheumatica primarily affects proximal muscles and joints, causing disability in older adults. […] Osteoporosis management and gastrointestinal ulcer prophylaxis should be initiated. […] Medications should be instituted to decrease fracture risk in patients on high-dose, long-term glucocorticoid therapy. […] Studies show that use of bisphosphonates, specifically alendronate (Fosamax) and risedronate (Actonel), can increase bone mineral density and decrease vertebral fractures in patients on long-term glucocorticoid therapy. […] Recommendations that address long-term corticosteroid complications are listed in Table 3. […] Immunization against pneumococcus and influenza is also necessary.
#14 Recognition and Management of Polymyalgia Rheumatica and Giant Cell Arteritis | AAFP
https://www.aafp.org/pubs/afp/issues/2013/1115/p676.html
Polymyalgia rheumatica primarily affects proximal muscles and joints, causing disability in older adults. […] Osteoporosis management and gastrointestinal ulcer prophylaxis should be initiated. […] Medications should be instituted to decrease fracture risk in patients on high-dose, long-term glucocorticoid therapy. […] Low-dose aspirin should be used as an adjunctive treatment to decrease the risk of ischemic events in patients with giant cell arteritis. […] Recommendations that address long-term corticosteroid complications are listed in Table 3. […] Studies show that use of bisphosphonates, specifically alendronate (Fosamax) and risedronate (Actonel), can increase bone mineral density and decrease vertebral fractures in patients on long-term glucocorticoid therapy. […] All patients should be monitored for long-term complications of high-dose corticosteroid use. […] Medications that protect patients from osteoporosis (such as bisphosphonates) and gastrointestinal ulcers (such as proton pump inhibitors) should be initiated. […] Immunization against pneumococcus and influenza is also necessary.
#15 Recognition and Management of Polymyalgia Rheumatica and Giant Cell Arteritis | AAFP
https://www.aafp.org/pubs/afp/issues/2013/1115/p676.html/1000
Polymyalgia rheumatica primarily affects proximal muscles and joints, causing disability in older adults. […] Osteoporosis management and gastrointestinal ulcer prophylaxis should be initiated. […] Medications should be instituted to decrease fracture risk in patients on high-dose, long-term glucocorticoid therapy. […] Studies show that use of bisphosphonates, specifically alendronate (Fosamax) and risedronate (Actonel), can increase bone mineral density and decrease vertebral fractures in patients on long-term glucocorticoid therapy. […] Recommendations that address long-term corticosteroid complications are listed in Table 3. […] Immunization against pneumococcus and influenza is also necessary.
#16 Polymyalgia Rheumatica (PMR) Treatment & Management: Approach Considerations, Diet and Activity, Consultations and Long-Term Monitoring
https://emedicine.medscape.com/article/330815-treatment
Calcium and vitamin D supplementation should be initiated in all patients with PMR who are starting corticosteroid therapy. […] European League Against Rheumatism/American College of Rheumatology collaborative guidelines conditionally recommend consideration of an individualized exercise program for patients with PMR, with the goals of maintaining muscle mass and function and reducing risk of falls, especially in older patients on long-term corticosteroids as well as frail patients. […] Appropriate immunizations should be administered, ideally before corticosteroid therapy is initiated. […] A baseline bone mineral density study (eg, dual-energy x-ray absorptiometry [DEXA] scan) is recommended at the onset of treatment. As most patients require corticosteroids for at least 1-2 years, bisphosphonate therapy is recommended to prevent corticosteroid-induced osteoporosis.
#17 Polymyalgia Rheumatica (PMR) Treatment & Management: Approach Considerations, Diet and Activity, Consultations and Long-Term Monitoring
https://emedicine.medscape.com/article/330815-treatment
Calcium and vitamin D supplementation should be initiated in all patients with PMR who are starting corticosteroid therapy. […] European League Against Rheumatism/American College of Rheumatology collaborative guidelines conditionally recommend consideration of an individualized exercise program for patients with PMR, with the goals of maintaining muscle mass and function and reducing risk of falls, especially in older patients on long-term corticosteroids as well as frail patients. […] Appropriate immunizations should be administered, ideally before corticosteroid therapy is initiated. […] A baseline bone mineral density study (eg, dual-energy x-ray absorptiometry [DEXA] scan) is recommended at the onset of treatment. As most patients require corticosteroids for at least 1-2 years, bisphosphonate therapy is recommended to prevent corticosteroid-induced osteoporosis.
#18 Polymyalgia Rheumatica (PMR) Guidelines: Guidelines Summary
https://emedicine.medscape.com/article/330815-guidelines
Glucocorticoids are the preferred treatment. […] An exercise program to help maintain muscular mass and function and reduce the risk of falls, particularly in frail patients with PMR and in older patients who are receiving long-term glucocorticoid therapy, is recommended by both guidelines.
#19 Bone-Friendly Exercises and Wellness for Polymyalgia Rheumatica
https://creakyjoints.org/polymyalgia-rheumatica/polymyalgia-rheumatica-bone-friendly-tips/
You want to do everything you can to protect your bones and decrease side effects from taking that medication. […] A bone-strengthening exercise program should include four main components, per Harvard Medical School: Weight-bearing exercises like walking, climbing stairs, playing tennis, and dancing to encourage your body to work against gravity (which helps to strengthen bones). […] The American College of Rheumatology guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis include recommendations for regular weight-bearing or resistance training exercise. […] As a rheumatology community, we always remember to put people on calcium and vitamin D prophylaxis [preventively], especially when theyre on high doses of prednisone for things like giant cell arteritis, which is related but not the same thing, says Dr. Dua. I think it might be overlooked a little bit in patients on these chronic low-dose steroids [like low-dose prednisone for PMR].
#20 Bone-Friendly Exercises and Wellness for Polymyalgia Rheumatica
https://creakyjoints.org/polymyalgia-rheumatica/polymyalgia-rheumatica-bone-friendly-tips/
You want to do everything you can to protect your bones and decrease side effects from taking that medication. […] A bone-strengthening exercise program should include four main components, per Harvard Medical School: Weight-bearing exercises like walking, climbing stairs, playing tennis, and dancing to encourage your body to work against gravity (which helps to strengthen bones). […] The American College of Rheumatology guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis include recommendations for regular weight-bearing or resistance training exercise. […] As a rheumatology community, we always remember to put people on calcium and vitamin D prophylaxis [preventively], especially when theyre on high doses of prednisone for things like giant cell arteritis, which is related but not the same thing, says Dr. Dua. I think it might be overlooked a little bit in patients on these chronic low-dose steroids [like low-dose prednisone for PMR].
#21 Polymyalgia rheumatica (PMR) | Causes, symptoms, treatments
https://versusarthritis.org/about-arthritis/conditions/polymyalgia-rheumatica-pmr/
Steroid treatment is usually very effective to treat polymyalgia rheumatica. […] Like all medicines, steroids can have side effects. One of the side effects of steroids is osteoporosis, which can cause bones to become thinner and then fracture. […] The nationally recommended treatment for this is medicine called bisphosphonates (biss-foss-fo-nates). These are a group of drugs that can slow down or prevent bone loss. You can ask your doctor about treatment with bisphosphonates. Examples include alendronate and risedronate. […] If you have polymyalgia rheumatica, you’ll need to find the right balance between rest and activity. Too much exercise is likely to make your symptoms worse, but activity usually helps to ease pain and stiffness in the muscles of the shoulders, hips and thighs. […] Weight-bearing exercise is good for maintaining bone strength and reducing the risk of osteoporosis.
#22 Polymyalgia Rheumatica: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/25215-polymyalgia-rheumatica
Researchers dont know the exact cause of polymyalgia rheumatica, so you cant prevent the condition. […] Polymyalgia rheumatica treatment begins with a low dose of corticosteroids. Your healthcare provider may recommend 10 mg (milligrams) to 15 mg per day of prednisone, which may rapidly relieve your pain and stiffness. If your symptoms improve, the steroid is gradually lessened over one to two years. In some instances, relapses may occur, and you may need a low dose of steroids long-term to prevent flares. […] Rest and exercise are also important factors in the treatment of polymyalgia rheumatica. Regular exercise can help you maintain muscle strength and joint flexibility. Good forms of exercise include riding a stationary bike, swimming, and walking.
#23 Polymyalgia Rheumatica – What You Need to Know
https://www.drugs.com/cg/polymyalgia-rheumatica.html
Exercise as directed. Exercise can help prevent or reduce pain. Exercise can also help you keep muscle mass and prevent falls. […] Go to physical therapy as directed. A physical therapist can teach you exercises to help keep muscle mass. He or she can also teach you exercises to improve range of motion in joints that are difficult to move. […] Use assistive devices as needed. A raised toilet seat or chair can help you stand more easily. Devices are available to help you reach items on high shelves if you have trouble reaching up. Your healthcare provider may recommend a cane or walker to help you keep your balance. […] Eat a variety of healthy foods. Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Healthy foods can help you have more energy. Ask if you need to be on a special diet.
#24 Delaware’s Trusted Polymyalgia Rheumatica Treatment
https://rheumatologyde.com/polymyalgia-rheumatica/
At the Rheumatology Center of Delaware, we specialize in osteoporosis care, offering personalized treatment plans designed to enhance bone health and prevent fractures. […] Regular monitoring, gradual steroid tapering, physical therapy, and a balanced diet support effective management. […] Incorporating physical therapy into the treatment plan can help maintain joint flexibility and muscle strength. A tailored exercise program designed by a physical therapist can improve mobility and reduce stiffness, enhancing the overall quality of life for polymyalgia rheumatica (PMR) patients. […] Treatment often begins with corticosteroids, and the original dose is gradually tapered under medical supervision to minimize side effects while effectively managing symptoms.
#25 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537274/
Deterrence and prevention strategies for PMR primarily revolve around early recognition, accurate diagnosis, and timely initiation of appropriate treatment. […] Since PMR predominantly affects individuals older than 50 years, proactive screening and awareness campaigns among this age group may facilitate early identification of symptoms, enabling prompt medical intervention. […] Additionally, raising awareness among healthcare professionals about the clinical features and diagnostic criteria for PMR can improve detection rates. […] Implementing routine monitoring of inflammatory markers, such as ESR and CRP, in older populations with musculoskeletal complaints can aid in early detection. […] Moreover, educating the public on lifestyle factors that may impact inflammatory conditions and promoting regular physical activity and a healthy diet may play a role in preventing or mitigating the severity of PMR. […] Overall, a multifaceted approach that combines public awareness, healthcare provider education, and proactive screening holds promise for enhancing deterrence and prevention efforts against the impact of PMR.
#26 Diet and Supplements for Polymyalgia Rheumatica (PMR)
https://www.arthritis-health.com/blog/diet-and-supplements-polymyalgia-rheumatica-pmr
Inflammatory joint pain from conditions such as polymyalgia rheumatica (PMR) may be aggravated or suppressed by certain foods. […] It is important to note that dietary changes and supplements are not quick-fixes or stand-alone treatments for PMR. […] Here are a few diet and supplement considerations for PMR. […] Omega-3 fatty acids can help reverse immune system responses to inflammation and protect against a recurrence of PMR. […] When you are on steroid treatment for PMR, you are at an increased risk of osteoporosis, fractures, and bone damage. Getting an adequate amount of calcium and vitamin D are especially important. […] Although dairy products are rich in calcium, full-fat dairy products and cheeses may increase joint inflammation in some people. […] When you decide to follow a healthy diet, it is important to abstain from foods that may promote inflammation.
#27 Diet and Supplements for Polymyalgia Rheumatica (PMR)
https://www.arthritis-health.com/blog/diet-and-supplements-polymyalgia-rheumatica-pmr
Inflammatory joint pain from conditions such as polymyalgia rheumatica (PMR) may be aggravated or suppressed by certain foods. […] It is important to note that dietary changes and supplements are not quick-fixes or stand-alone treatments for PMR. […] Here are a few diet and supplement considerations for PMR. […] Omega-3 fatty acids can help reverse immune system responses to inflammation and protect against a recurrence of PMR. […] When you are on steroid treatment for PMR, you are at an increased risk of osteoporosis, fractures, and bone damage. Getting an adequate amount of calcium and vitamin D are especially important. […] Although dairy products are rich in calcium, full-fat dairy products and cheeses may increase joint inflammation in some people. […] When you decide to follow a healthy diet, it is important to abstain from foods that may promote inflammation.
#28 Polymyalgia Rheumatica: A Severe, Self-Limiting Disease
https://www.uspharmacist.com/article/polymyalgia-rheumatica-a-severe-self-limiting-disease
While there have been no major studies on the relationship between inflammatory foods (e.g., wheat products) and PMR, many patients have reported that by following a paleo or gluten-free diet and exercising, they have been able to control their symptoms and taper off the steroids in a period of up to 1 year. […] To prevent osteopenia or osteoporosis during the treatment, supplementation with calcium (1,000-1,200 mg/day) and vitamin D (up to 1,000 IU/day) should be initiated in all patients with PMR who are starting corticosteroid therapy. […] Because relapses are more likely to occur during the initial 18 months of therapy and within 1 year of corticosteroid withdrawal, all patients should be monitored for symptom recurrence throughout corticosteroid tapering and until 12 months after cessation of therapy.
#29 Polymyalgia rheumatica (PMR) | Causes, symptoms, treatments
https://versusarthritis.org/about-arthritis/conditions/polymyalgia-rheumatica-pmr/
Ensuring you get enough calcium and vitamin D, and that you do some weight-bearing exercise will reduce the risk of getting osteoporosis. […] If you’re on steroid treatment, it’s recommended you aim for a daily intake of 700-1200 mg of calcium. […] Vitamin D is needed to help the body absorb calcium. […] Because of this, and because it’s an important nutrient, it’s recommended that we all take vitamin D supplements in the autumn and winter months.
#30 Polymyalgia Rheumatica: A Severe, Self-Limiting Disease
https://www.uspharmacist.com/article/polymyalgia-rheumatica-a-severe-self-limiting-disease
While there have been no major studies on the relationship between inflammatory foods (e.g., wheat products) and PMR, many patients have reported that by following a paleo or gluten-free diet and exercising, they have been able to control their symptoms and taper off the steroids in a period of up to 1 year. […] To prevent osteopenia or osteoporosis during the treatment, supplementation with calcium (1,000-1,200 mg/day) and vitamin D (up to 1,000 IU/day) should be initiated in all patients with PMR who are starting corticosteroid therapy. […] Because relapses are more likely to occur during the initial 18 months of therapy and within 1 year of corticosteroid withdrawal, all patients should be monitored for symptom recurrence throughout corticosteroid tapering and until 12 months after cessation of therapy.
#31 Diet and Supplements for Polymyalgia Rheumatica (PMR)
https://www.arthritis-health.com/blog/diet-and-supplements-polymyalgia-rheumatica-pmr
Inflammatory joint pain from conditions such as polymyalgia rheumatica (PMR) may be aggravated or suppressed by certain foods. […] It is important to note that dietary changes and supplements are not quick-fixes or stand-alone treatments for PMR. […] Here are a few diet and supplement considerations for PMR. […] Omega-3 fatty acids can help reverse immune system responses to inflammation and protect against a recurrence of PMR. […] When you are on steroid treatment for PMR, you are at an increased risk of osteoporosis, fractures, and bone damage. Getting an adequate amount of calcium and vitamin D are especially important. […] Although dairy products are rich in calcium, full-fat dairy products and cheeses may increase joint inflammation in some people. […] When you decide to follow a healthy diet, it is important to abstain from foods that may promote inflammation.
#32 Polymyalgia Rheumatica â Symptoms & Treatments | MHA
https://muscha.org/polymyalgia-rheumatica/
Polymyalgia rheumatica can be treated effectively with medication and lifestyle changes. […] You can do many things to help yourself including: Learn more about polymyalgia rheumatica knowing as much as possible about your condition means that you can make informed decisions about your healthcare and play an active role in the management of your condition. […] Get active low-impact activities such as swimming or walking can help reduce muscle pain and stiffness. […] Eat well eating a balanced diet can help provide you with better energy levels, help to maintain your weight, and give you a greater sense of wellbeing. […] Ask your doctor to check your calcium and vitamin D levels steroid tablets reduce the amount of calcium your body absorbs, while vitamin D is important in helping your body absorb and process calcium.
#33 Polymyalgia Rheumatica â Symptoms & Treatments | MHA
https://muscha.org/polymyalgia-rheumatica/
Dont smoke smoking cigarettes is not only bad for your general health but it can also worsen your polymyalgia rheumatica symptoms and make it harder to treat. […] Pace yourself plan and organise your activities so you make the most of your energy. […] Stay at work its good for your health and wellbeing. […] Join a peer support group dealing with a chronic condition can be isolating. Being able to speak with others who understand your condition can be a great relief.
#34 Polymyalgia Rheumatica â Symptoms & Treatments | MHA
https://muscha.org/polymyalgia-rheumatica/
Dont smoke smoking cigarettes is not only bad for your general health but it can also worsen your polymyalgia rheumatica symptoms and make it harder to treat. […] Pace yourself plan and organise your activities so you make the most of your energy. […] Stay at work its good for your health and wellbeing. […] Join a peer support group dealing with a chronic condition can be isolating. Being able to speak with others who understand your condition can be a great relief.
#35 Polymyalgia Rheumatica – What You Need to Know
https://www.drugs.com/cg/polymyalgia-rheumatica.html
Exercise as directed. Exercise can help prevent or reduce pain. Exercise can also help you keep muscle mass and prevent falls. […] Go to physical therapy as directed. A physical therapist can teach you exercises to help keep muscle mass. He or she can also teach you exercises to improve range of motion in joints that are difficult to move. […] Use assistive devices as needed. A raised toilet seat or chair can help you stand more easily. Devices are available to help you reach items on high shelves if you have trouble reaching up. Your healthcare provider may recommend a cane or walker to help you keep your balance. […] Eat a variety of healthy foods. Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Healthy foods can help you have more energy. Ask if you need to be on a special diet.
#36 Polymyalgia Rheumatica (PMR) Treatment & Management: Approach Considerations, Diet and Activity, Consultations and Long-Term Monitoring
https://emedicine.medscape.com/article/330815-treatment
Because relapses are more likely to occur during the initial 18 months of therapy and within 1 year of corticosteroid withdrawal, with a frequency of approximately 50%, all patients should be monitored for symptom of recurrence throughout corticosteroid tapering and for 12 months after cessation of therapy. […] Patients with PMR should be monitored regularly and carefully for symptoms and signs suggestive of GCA development.
#37 Polymyalgia Rheumatica: A Severe, Self-Limiting Disease
https://www.uspharmacist.com/article/polymyalgia-rheumatica-a-severe-self-limiting-disease
While there have been no major studies on the relationship between inflammatory foods (e.g., wheat products) and PMR, many patients have reported that by following a paleo or gluten-free diet and exercising, they have been able to control their symptoms and taper off the steroids in a period of up to 1 year. […] To prevent osteopenia or osteoporosis during the treatment, supplementation with calcium (1,000-1,200 mg/day) and vitamin D (up to 1,000 IU/day) should be initiated in all patients with PMR who are starting corticosteroid therapy. […] Because relapses are more likely to occur during the initial 18 months of therapy and within 1 year of corticosteroid withdrawal, all patients should be monitored for symptom recurrence throughout corticosteroid tapering and until 12 months after cessation of therapy.
#38 Polymyalgia rheumatica: An updated review | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/87/9/549
Polymyalgia rheumatica (PMR) is easily recognized when it presents classically, ie, in an older woman with pelvic girdle stiffness that improves over the day, elevated inflammatory markers, and a rapid response to prednisone therapy. […] To help avoid relapse, therapy should continue until symptoms resolve, followed by slow tapering. […] The mainstay of treatment of PMR is oral prednisone therapy. […] According to the latest EULAR/ACR guidelines, prednisone therapy should be within the range of 12.5 to 25 mg, using the minimum effective dosage to achieve remission. Tapering should be individualized once remission is achieved. […] Another debated issue is treatment duration, which should generally be patient-specific and symptom-driven. The glucocorticoid dosage that controls symptoms is typically maintained for 2 to 4 weeks after pain and stiffness have resolved. Dosage is then decreased by about 20% every 2 to 4 weeks, as tolerated, to the minimum amount needed to maintain symptom suppression.
#39 Polymyalgia rheumatica: An updated review | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/87/9/549
Polymyalgia rheumatica (PMR) is easily recognized when it presents classically, ie, in an older woman with pelvic girdle stiffness that improves over the day, elevated inflammatory markers, and a rapid response to prednisone therapy. […] To help avoid relapse, therapy should continue until symptoms resolve, followed by slow tapering. […] The mainstay of treatment of PMR is oral prednisone therapy. […] According to the latest EULAR/ACR guidelines, prednisone therapy should be within the range of 12.5 to 25 mg, using the minimum effective dosage to achieve remission. Tapering should be individualized once remission is achieved. […] Another debated issue is treatment duration, which should generally be patient-specific and symptom-driven. The glucocorticoid dosage that controls symptoms is typically maintained for 2 to 4 weeks after pain and stiffness have resolved. Dosage is then decreased by about 20% every 2 to 4 weeks, as tolerated, to the minimum amount needed to maintain symptom suppression.
#40 Polymyalgia rheumatica: An updated review | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/87/9/549
After 2 relapses, a steroid-sparing agent such as methotrexate, azathioprine, a TNF inhibitor, or an interleukin 6 (IL-6) receptor blocker can be tried. […] The EULAR/ACR guidelines recommend the early introduction of methotrexate therapy in addition to glucocorticoids in patients at high risk for relapse or prolonged therapy and for those who develop glucocorticoid-related adverse effects. […] Although data are still being accumulated, tocilizumab appears to be a promising glucocorticoid-sparing option for treating patients with PMR. However, there are poorly understood risks of long-term use, including possible increases in infections and cardiovascular events. Therefore, careful consideration is advised before starting IL-6 inhibitors in patients with PMR until more evidence is available.
#41 Polymyalgia rheumatica: An updated review | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/87/9/549
After 2 relapses, a steroid-sparing agent such as methotrexate, azathioprine, a TNF inhibitor, or an interleukin 6 (IL-6) receptor blocker can be tried. […] The EULAR/ACR guidelines recommend the early introduction of methotrexate therapy in addition to glucocorticoids in patients at high risk for relapse or prolonged therapy and for those who develop glucocorticoid-related adverse effects. […] Although data are still being accumulated, tocilizumab appears to be a promising glucocorticoid-sparing option for treating patients with PMR. However, there are poorly understood risks of long-term use, including possible increases in infections and cardiovascular events. Therefore, careful consideration is advised before starting IL-6 inhibitors in patients with PMR until more evidence is available.
#42 Prescribing for polymyalgia rheumatica
https://australianprescriber.tg.org.au/articles/prescribing-for-polymyalgia-rheumatica.html
There is great impetus to develop treatment alternatives to corticosteroids. However, there is currently no alternative drug in polymyalgia rheumatica which is supported by good evidence and is affordable. Steroid-sparing drugs, such as methotrexate, are therefore not currently recommended to be started soon after diagnosis, as is the case in rheumatoid arthritis. […] Methotrexate is currently recommended by both international and local guidelines as the first-line steroid-sparing drug to consider in polymyalgia rheumatica. These recommendations acknowledge that the evidence to support this advice is of poor quality. […] Polymyalgia rheumatica can be hard to diagnose and to treat optimally. While corticosteroids are effective and necessary to prevent disease-related morbidity, they have a burden of morbidity themselves and no steroid-sparing drug has yet emerged as ideal for routine use. Close clinical monitoring is important to detect the evolution of giant cell arteritis and to minimise and manage the adverse effects of therapy. […] More research is required into the mechanisms behind corticosteroid-related damage in polymyalgia rheumatica. There is also a need to find ways to predict which patients are likely to require prolonged corticosteroids, and to devise a pragmatic therapeutic approach for them.
#43 Prescribing for polymyalgia rheumatica
https://australianprescriber.tg.org.au/articles/prescribing-for-polymyalgia-rheumatica.html
There is great impetus to develop treatment alternatives to corticosteroids. However, there is currently no alternative drug in polymyalgia rheumatica which is supported by good evidence and is affordable. Steroid-sparing drugs, such as methotrexate, are therefore not currently recommended to be started soon after diagnosis, as is the case in rheumatoid arthritis. […] Methotrexate is currently recommended by both international and local guidelines as the first-line steroid-sparing drug to consider in polymyalgia rheumatica. These recommendations acknowledge that the evidence to support this advice is of poor quality. […] Polymyalgia rheumatica can be hard to diagnose and to treat optimally. While corticosteroids are effective and necessary to prevent disease-related morbidity, they have a burden of morbidity themselves and no steroid-sparing drug has yet emerged as ideal for routine use. Close clinical monitoring is important to detect the evolution of giant cell arteritis and to minimise and manage the adverse effects of therapy. […] More research is required into the mechanisms behind corticosteroid-related damage in polymyalgia rheumatica. There is also a need to find ways to predict which patients are likely to require prolonged corticosteroids, and to devise a pragmatic therapeutic approach for them.
#44 Traditional and Emerging Strategies for Managing Polymyalgia Rheumatica: Insights into New Treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC11546695/
Glucocorticoids are the primary treatment for isolated PMR but are associated with comorbidities, especially in patients with pre-existing conditions or frequent relapses. […] Glucocorticoid-sparing agents, such as methotrexate and biologics, in particular tocilizumab and sarilumab, offer alternatives, improving symptoms and reducing glucocorticoid use. […] While biologic agents reduce long-term side effects and help achieve disease remission, their use must consider potential side effects and higher costs compared to traditional therapies. […] The 2015 EULAR/ACR guidelines recommend considering early methotrexate use for patients at high risk of relapses or those facing prolonged therapy, especially if they have comorbidities or are on other medications that increase the likelihood of glucocorticoid side effects.
#45 Traditional and Emerging Strategies for Managing Polymyalgia Rheumatica: Insights into New Treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC11546695/
The use of anti-IL-6 receptor agents was linked to rapid improvement of pain and stiffness in patients with PMR. Additionally, these agents facilitate a reduction in the cumulative glucocorticoid dosage, thereby lowering the risk of side effects associated with long-term glucocorticoid therapy. […] The only biologic agent approved by the FDA specifically for the treatment of PMR is sarilumab, which is administered subcutaneously every two weeks. This biologic agent has a favorable safety profile and can provide sustained remission, making it especially beneficial for patients who have difficulty maintaining disease remission with traditional therapies.
#46 Traditional and Emerging Strategies for Managing Polymyalgia Rheumatica: Insights into New Treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC11546695/
The use of anti-IL-6 receptor agents was linked to rapid improvement of pain and stiffness in patients with PMR. Additionally, these agents facilitate a reduction in the cumulative glucocorticoid dosage, thereby lowering the risk of side effects associated with long-term glucocorticoid therapy. […] The only biologic agent approved by the FDA specifically for the treatment of PMR is sarilumab, which is administered subcutaneously every two weeks. This biologic agent has a favorable safety profile and can provide sustained remission, making it especially beneficial for patients who have difficulty maintaining disease remission with traditional therapies.
#47 Prescribing for polymyalgia rheumatica
https://australianprescriber.tg.org.au/articles/prescribing-for-polymyalgia-rheumatica.html
There is great impetus to develop treatment alternatives to corticosteroids. However, there is currently no alternative drug in polymyalgia rheumatica which is supported by good evidence and is affordable. Steroid-sparing drugs, such as methotrexate, are therefore not currently recommended to be started soon after diagnosis, as is the case in rheumatoid arthritis. […] Methotrexate is currently recommended by both international and local guidelines as the first-line steroid-sparing drug to consider in polymyalgia rheumatica. These recommendations acknowledge that the evidence to support this advice is of poor quality. […] Polymyalgia rheumatica can be hard to diagnose and to treat optimally. While corticosteroids are effective and necessary to prevent disease-related morbidity, they have a burden of morbidity themselves and no steroid-sparing drug has yet emerged as ideal for routine use. Close clinical monitoring is important to detect the evolution of giant cell arteritis and to minimise and manage the adverse effects of therapy. […] More research is required into the mechanisms behind corticosteroid-related damage in polymyalgia rheumatica. There is also a need to find ways to predict which patients are likely to require prolonged corticosteroids, and to devise a pragmatic therapeutic approach for them.
#48 Polymyalgia rheumatica: treatment reviews are needed – NIHR Evidence
https://evidence.nihr.ac.uk/alert/polymyalgia-rheumatica-treatment-reviews-and-falls-assessment/
Many people with polymyalgia rheumatica would benefit from a falls assessment when first diagnosed, and regular treatment reviews. […] To prevent fractures, people with polymyalgia rheumatica should also take calcium and vitamin D supplements to strengthen bones. […] Those at particularly high risk of fractures (people over 65, those who have had a fragility fracture) should also take osteoporosis treatments (such as bisphosphonates). […] This research emphasises the importance of assessing people with polymyalgia rheumatica for falls at the earliest opportunity. This gives those at high risk the opportunity to take medicines to protect bones. They may also benefit from interventions to prevent falls. […] Patients should have a falls risk assessment. More than 2 falls a year is a risk factor for fracture and increases the FRAX assessment result.
#49 Polymyalgia rheumatica: treatment reviews are needed – NIHR Evidence
https://evidence.nihr.ac.uk/alert/polymyalgia-rheumatica-treatment-reviews-and-falls-assessment/
Many people with polymyalgia rheumatica would benefit from a falls assessment when first diagnosed, and regular treatment reviews. […] To prevent fractures, people with polymyalgia rheumatica should also take calcium and vitamin D supplements to strengthen bones. […] Those at particularly high risk of fractures (people over 65, those who have had a fragility fracture) should also take osteoporosis treatments (such as bisphosphonates). […] This research emphasises the importance of assessing people with polymyalgia rheumatica for falls at the earliest opportunity. This gives those at high risk the opportunity to take medicines to protect bones. They may also benefit from interventions to prevent falls. […] Patients should have a falls risk assessment. More than 2 falls a year is a risk factor for fracture and increases the FRAX assessment result.
#50 Polymyalgia rheumatica: treatment reviews are needed – NIHR Evidence
https://evidence.nihr.ac.uk/alert/polymyalgia-rheumatica-treatment-reviews-and-falls-assessment/
Many people with polymyalgia rheumatica would benefit from a falls assessment when first diagnosed, and regular treatment reviews. […] To prevent fractures, people with polymyalgia rheumatica should also take calcium and vitamin D supplements to strengthen bones. […] Those at particularly high risk of fractures (people over 65, those who have had a fragility fracture) should also take osteoporosis treatments (such as bisphosphonates). […] This research emphasises the importance of assessing people with polymyalgia rheumatica for falls at the earliest opportunity. This gives those at high risk the opportunity to take medicines to protect bones. They may also benefit from interventions to prevent falls. […] Patients should have a falls risk assessment. More than 2 falls a year is a risk factor for fracture and increases the FRAX assessment result.
#51 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537274/
Deterrence and prevention strategies for PMR primarily revolve around early recognition, accurate diagnosis, and timely initiation of appropriate treatment. […] Since PMR predominantly affects individuals older than 50 years, proactive screening and awareness campaigns among this age group may facilitate early identification of symptoms, enabling prompt medical intervention. […] Additionally, raising awareness among healthcare professionals about the clinical features and diagnostic criteria for PMR can improve detection rates. […] Implementing routine monitoring of inflammatory markers, such as ESR and CRP, in older populations with musculoskeletal complaints can aid in early detection. […] Moreover, educating the public on lifestyle factors that may impact inflammatory conditions and promoting regular physical activity and a healthy diet may play a role in preventing or mitigating the severity of PMR. […] Overall, a multifaceted approach that combines public awareness, healthcare provider education, and proactive screening holds promise for enhancing deterrence and prevention efforts against the impact of PMR.
#52 Uncovering the Mystery: Advancements in the Treatment of Polymyalgia Rheumatica
https://www.hcplive.com/view/uncovering-the-mystery-advancements-treatment-polymyalgia-rheumatica
Despite the recent advancements in the treatment of polymyalgia rheumatica, a need for more research focused on finding non-steroidal treatment options remains. […] In addition to pharmaceutical treatments, patients are often prescribed calcium and vitamin D supplements to prevent potential bone loss from long-term steroid therapy. They are also encouraged to eat a healthy diet, engage in regular exercise, ensure proper sleeping habits, and use assistive devices if necessary. […] Because polymyalgia rheumatica is a common condition, and patients should be aware of symptoms such as prolonged pain and stiffness in the shoulders and thigh girdles, Nune stressed. If they experience these symptoms, they should take them seriously. It is important to treat patients in a timely manner because if left untreated, they may suffer from irreversible visual loss and other complications, such as reduced daily living activities and systemic symptoms.
#53 Uncovering the Mystery: Advancements in the Treatment of Polymyalgia Rheumatica
https://www.hcplive.com/view/uncovering-the-mystery-advancements-treatment-polymyalgia-rheumatica
Despite the recent advancements in the treatment of polymyalgia rheumatica, a need for more research focused on finding non-steroidal treatment options remains. […] In addition to pharmaceutical treatments, patients are often prescribed calcium and vitamin D supplements to prevent potential bone loss from long-term steroid therapy. They are also encouraged to eat a healthy diet, engage in regular exercise, ensure proper sleeping habits, and use assistive devices if necessary. […] Because polymyalgia rheumatica is a common condition, and patients should be aware of symptoms such as prolonged pain and stiffness in the shoulders and thigh girdles, Nune stressed. If they experience these symptoms, they should take them seriously. It is important to treat patients in a timely manner because if left untreated, they may suffer from irreversible visual loss and other complications, such as reduced daily living activities and systemic symptoms.
#54 Polymyalgia Rheumatica – Harvard Health
https://www.health.harvard.edu/a_to_z/polymyalgia-rheumatica-a-to-z
There is no known way to prevent polymyalgia rheumatica. […] Treatment may be required for years. But the outlook for people with polymyalgia rheumatica is excellent. […] However, effective therapy is available to prevent these complications.
#55 Polymyalgia Rheumatica | Arthritis Foundation
https://www.arthritis.org/diseases/polymyalgia-rheumatica
Many people with PMR can stop medication after a year or two and remain symptom-free, but others may need life-long treatment to prevent relapses. […] To minimize risks associated with treatment: Be sure you fully understand the risks and benefits of corticosteroids. Mild PMR sometimes goes away on its own, so discuss this possibility with your health care provider. […] While taking a corticosteroid drug, you should be closely monitored for side effects. Be aware of changes and report them immediately to your doctor. […] Ask your doctor about taking calcium and vitamin D supplements while you’re on steroids to help prevent bone loss and reduce the risk of fractures. Some people lose 10% to 20% of their bone mass in the first six months of corticosteroid therapy. […] Get plenty of regular exercise to preserve strength and flexibility and counter some of the side effects of treatment. […] Emphasize a healthy, anti-inflammatory diet and restorative sleep. […] Corticosteroids can affect your memory and mood; know how to counter these problems with deep breathing, meditation or other healthy stress relievers that work for you.