Treatment of Polymyalgia Rheumatica

Featuring Dr. John Watterson, MD, FRCPC

Duration: 2 minutes, 37 secondsVideo Title: Treatment of Polymyalgia Rheumatica

Polymyalgia rheumatica is a rheumatic disease, characterized by pain and stiffness around the proximal limbs, the shoulders and the hips.  

The cause is not known. It seems to be more common in the fall and spring months, so it may be triggered by an infectious etiology, although we don't know this for certain.

It's a disorder that, when it comes on, it is treatable once it's recognized. It's a disorder that, in most people, gets better over a period of 12 to 36 months. In a minority, it may have a more chronic disease course.  

In individuals who respond to treatment and are able to taper and discontinue treatment over time, there is a relapse rate approaching 30 to 40 percent over a lifetime. So, once your healthcare professional has felt that this is a potential diagnosis, typically, one will be put on a dose of prednisone between 10 and 20 milligrams daily.

You'll be seen again in about a week's time to see what the response was like. And the classic response is, "I feel 100 percent better. My symptoms are alleviated."  

Now, the difficulty comes because polymyalgia rheumatica, being a systemic autoimmune condition, is not one where it lasts for a finite period. Most patients will receive prednisone for about a year, sometimes up to 36 months.

During that period of time, your healthcare physician that's following this condition will be measuring acute phase reactants, which I spoke earlier about, the ESR and the C-reactive protein, typically on a monthly basis, as well as seeing you individually to see whether you're responding to therapy and remain asymptomatic. During the follow-up period, the prednisone dose is slowly tapered and eventually discontinued. 

Polymyalgia rheumatica, because of the nature of this disorder, causing severe pain and stiffness and affecting a certain population whom remain independent-living, is something that does need rapid treatment. If not treated, symptoms and signs will worsen to the point where individuals can become dependent on others for activities of daily living. 

Additionally, polymyalgia rheumatica can be associated with other inflammatory disorders, most common being giant cell arteritis or temporal arteritis, which is an inflammatory condition of the blood vessels. This can be a very serious complication and can lead to manifestations including stroke and blindness. 

So, if someone you know or yourself has features of polymyalgia rheumatica, you should seek attention with your primary care physician. He or she will do a number of tests and likely send you on to a rheumatologist for consultation.  

Presenter: Dr. John Watterson, Rheumatologist, Victoria, BC

Local Practitioners: Rheumatologist