Polymyalgia rheumatica - Treating polymyalgia rheumatica

Steroid medication (corticosteroids) is the preferred treatment for polymyalgia rheumatica (PMR). A type of corticosteroid called prednisolone is usually prescribed.

Prednisolone

Prednisolone works by blocking the effects of certain chemicals that cause inflammation inside your body. It does not cure polymyalgia rheumatica, but it can help relieve the symptoms.

When used to treat polymyalgia rheumatica, prednisolone is taken orally. Most people will be prescribed several tablets to take once a day.

You will be prescribed a high dose of prednisolone initially and the dosage will be gradually reduced every one to two months.

Although your symptoms should improve significantly within a few days of starting your treatment, you will probably need to continue taking a low dose of prednisolone for about two years.

In many cases, polymyalgia rheumatica improves on its own after this time. However, there is a chance that the condition will return (relapse) once treatment stops.

Side effects

About one in 20 people who take prednisolone will experience changes in their mental state when they take the medication.

For example, you may feel very depressed and suicidal, very anxious or very confused. Some people also experience hallucinations (feeling, seeing or hearing things that are not there). Contact your GP as soon as possible if you experience changes to your mental state. 

Other side effects of prednisolone include:

• increased appetite that often leads to weight gain
• increased blood pressure
• mood changes, such as becoming aggressive or irritable with people
• weakening of the bones (osteoporosis)
• stomach ulcers
• increased risk of infection, particularly the virus that causes chickenpox and shingles (varicella-zoster virus) 

Seek immediate medical advice if you think that you have been exposed to the varicella-zoster virus or if a member of your household develops chickenpox or shingles.

The risk of these side effects should improve as your dosage of prednisolone is decreased.

See side effects of corticosteroids for more information about how these side effects may affect you and how they are treated.

Other medications

Sometimes, other medications may be combined with corticosteroids to help prevent relapses or to allow your dose of prednisolone to be reduced.

Some people are prescribed immunosuppressant medication, such as methotrexate. This is used to reduce or suppress the immune system (the body's defence against illness and infection). It may be helpful for people with polymyalgia rheumatica who have frequent relapses or don't respond to normal steroid treatment.

Your doctor may recommend painkillers such as paracetamol to help relieve pain while your dose of prednisolone is reduced.

Follow-up

Your GP will ask you to attend regular follow-up appointments so they can check how well you are responding to treatment, whether your dosage of prednisolone needs to be adjusted, and how well you are coping with the side effects of the medication.

During these appointments, you will have blood tests to check the levels of inflammation inside your body.

Follow-up appointments are usually recommended every few weeks for the first three months and then at three- to six-monthly intervals after this time.

If you experience a return of your symptoms during any part of your treatment, contact your GP as your dosage may need to be adjusted.