The treatment for polymyalgia rheumatica (PMR) primarily involves the use of corticosteroids, with the addition of methotrexate or biological agents in certain cases.
Corticosteroids
- Initiation: Corticosteroids should be initiated as soon as the diagnosis of PMR is made
- Preference over NSAIDs: Corticosteroids are preferred over NSAIDs in patients with PMR
- Dosing and duration: The minimally effective duration of corticosteroid therapy is recommended, with the duration of therapy individualized to achieve adequate efficacy with the shortest duration
- Tapering: In patients with a relapse, the dose should be increased to the pre-relapse dose and then decreased gradually within 4–8 weeks to the dose at which the relapse occurred
Methotrexate
- Initiation: Methotrexate is recommended for consideration in patients with clinical relapse without significant response to corticosteroids, in those with corticosteroid-related adverse effects , and in patients at high risk for relapse and in whom corticosteroid-related adverse events are more likely to occur
Biological agents
- Tocilizumab: In patients with new-onset PMR undergoing rapid glucocorticoid tapering, tocilizumab was superior to placebo regarding sustained glucocorticoid-free remission, time to relapse, and cumulative glucocorticoid dose
- Sarilumab: Sarilumab showed significant efficacy in achieving sustained remission and reducing the cumulative glucocorticoid dose in patients with a relapse of PMR during glucocorticoid tapering
In conclusion, the treatment of PMR involves a combination of corticosteroids, methotrexate, and biological agents, tailored to the individual patient's disease severity, risk of relapse, and potential for adverse events related to corticosteroid therapy.