PMR is an inflammatory condition that causes pain and stiffness in the muscles, usually around the upper arms, shoulders, neck and hips or thighs. The stiffness is worse in the mornings and can severely limit movement and activities. The cause of polymyalgia rheumatica is not known, but it is a fairly common condition affecting about 1-2% of the population. It usually develops in people aged 60–70 years and is more common in women. The condition is treated with painkillers and steroid medication.
Recommendations or guidelines for treatment are needed to help to standardise the care that people receive and support doctors in making decisions.
Two societies – EULAR (European League Against Rheumatism) and ACR (American College of Rheumatology) have worked together to develop these recommendations that were published in 2015.
The recommendations say that it is important to assess each patient holistically, looking at their demographics, disease severity, other co-existent diseases and risk factors for side effects from steroids, as well as taking into account patient choice. The authors of the recommendations emphasize that it is important to make sure that the diagnosis of PMR is confirmed properly before starting steroids
- Use steroids rather than anti-inflammatory painkillers, except where short-term pain relief is needed for other conditions
- Use the lowest possible dose of steroid
- Higher doses of steroid may be used as needed in patients with high risk of recurring disease and a low risk of side effects from the steroids
- The dose of steroid should be reduced once symptoms are better and patients monitored
- Steroid injections can be considered instead of oral steroids where needed
- Daily oral steroids should be given in a single dose
- Methotrexate may be considered in severe disease or for patients who get no response from steroids or cannot use them
- Biologic medicines such as TNF-inhibitors should not be used
- An exercise programme may help to maintain muscle mass and function
- Chinese herbal preparations should not be used