Weyand CM, Fullbright JW, Evans JM, Hunder GG, Goronzy JJ: Corticosteroid requirements in polymyalgia rheumatica. MAC and RC designed the study; MAC, RC and MP followed clinically the patient's cohort; MP performed US; MAC performed the statistical analysis; MAC, RC and CM drafted the manuscript and revised it critically; all the authors read the final manuscript and gave their approval. J Rheumatol. Morning stiffness (for more than 45 minutes). The patients were instructed to record on a diary their clinical status and the exact day in which remission was achieved. PubMed In contrast, previous data on PMR [12] and rheumatoid arthritis [13] have reported higher disease severity and lower rate of response to GC in women. Glucocorticoids should be tapered off and discontinued after a year or possibly two in most cases. When taking prednisone, the lowest effective dose should be prescribed. None of the features investigated by physical examination could differentiate responders from non-responders (data not shown). 1985, 79: 309-15. Cookies policy. 3 0 obj the mainstay of treatment of polymyalgia rheumatica (PMR) is oral glucocorticoids, but randomized controlled trials of treatment are lacking. Kyle V, Hazleman BL: Treatment of polymyalgia rheumatic and giant cell arteritis. This observation suggests that a close follow-up in the first days after diagnosis and treatment initiation is important to ensure that the patient is administered an adequate prednisone dosage. Clinica Reumatologica, Dipartimento di Medicina Interna, Università di Genova, Viale Benedetto XV, 6, 16132, Genova, Italy, Carlomaurizio Montecucco & Roberto Caporali, You can also search for this author in I am at the end of my journey with PMR and GCA and have been tapering prednisone in order to get off of it. Arch Intern Med. Dasgupta B, Borg FA, Hassan N, Barraclough K, Bourke B, Fulcher J, Hollywood J, Hutchings A, Kyle V, Nott J, Power M, Samanta A: BSR and BHPR guidelines for the management of polymyalgia rheumatica. This work was supported in part by a grant from the University of Genova (Fondi di Ateneo). Ann Rheum Dis. 2 0 obj : Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study. Ann Rheum Dis. A prospective two-year study in 273 patients. Ntatsaki E, Watts RA: Management of polymyalgia rheumatica. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/12/94/prepub. Scand J Rheumatol. endobj <> I also take Nabumetone (anti-inflammatory) 500 mg four times per day. Cimmino, M.A., Parodi, M., Montecucco, C. et al. © 2020 BioMed Central Ltd unless otherwise stated. 1989, 48: 658-661. Manage cookies/Do not sell my data we use in the preference centre. New guidelines are a step forward, but may unanswered questions remain. Narvàez J, Nolla-Solé JM, Clavaguera MT, Valverde-García Roig-Escofet D: Longterm therapy in polymyalgia rheumatica: effect of coexistent temporal arteritis. BMC Musculoskeletal Disorders However, due to lack of clinical information, it is impossible to derive from these papers how effective was GC in the initial period of treatment. It included the evaluation of gleno-humeral synovitis (hypoechoic or anechoic effusion larger than 2 mm when measured with a posterior approach and arm in external rotation, or larger than 3.8 mm when measured in the axillary recess between bone and capsule), long head biceps tenosynovitis (hypoechoic or anechoic effusion of the tendon's sheath with diameter larger than 1.4 mm), and subacromial/subdeltoid bursitis (hypoechoic or anechoic effusion with largest sagittal diameter larger than 2 mm). The only controlled study suggests that initial prednisone doses ≤ 10 mg is associated with high incidence of recurrences, whereas doses ≥ 20 mg are associated with considerable side effects [3]. They also suggest that 0.20 mg … Prednisolone doses of 10 mg/d or higher seemed to control initial PMR more efficiently than lower doses, and doses of 15 mg/d or lower appeared to be as effective as higher doses. For example, if your dose is 40mg daily, your doctor may tell you to take 8 tablets (8 x 5mg) all at the same time. N Engl J Med. Their dose of prednisone had been increased within one month from initiation of therapy between 2.5 and 12.5 mg/day with a resulting mean dose of 21.1 ± 3.2 mg/day. There was a significant difference by repeated measures ANOVA between responders and non-responders (p = 0.044) and within groups (p < 0.001). 10.1093/rheumatology/kep303a. endobj In multivariate analysis, the only factor predicting a good response was low weight (p = 0.004); the higher response rate observed in women was explained by their lower weight. Frequencies were compared by Fischer's exact test. Kyle V, Hazleman BL: Treatment of polymyalgia rheumatic and giant cell arteritis. Relation between steroid dosing and steroid associated side effects. Google Scholar. However, since no comparison was made between different treatments, we think it could not have biased the results. Below are the links to the authors’ original submitted files for images. 11-13 Moderate-dose corticosteroids have been the first-line treatment for over 50 years, but were introduced before the widespread use of placebo-controlled trials to confirm effectiveness. Confirm PMR Trial of therapy Prednisolone 15mg daily for 3 days Assess clinical and inflammatory marker response Good clinical response No clinical improvement Stop prednisolone and review diagnosis 3.
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