Managing Polymyalgia Rheumatica: A Treatment Guide
If you have polymyalgia rheumatica (PMR) — an inflammatory disease seen mostly in older adults that causes pain and stiffness in areas like your neck, shoulders, and around your hips — it’s important to seek effective treatment for the condition.
Polymyalgia rheumatica tends to respond well to treatment — often within just a few days — although it may take some time to find the right medication or combination of medications that works for you. Polymyalgia rheumatica management may involve physical therapy and exercises, along with other lifestyle measures like a healthy diet.
Polymyalgia rheumatica treatment nearly always involves medications called corticosteroids (also known simply as steroids). While these drugs tend to be highly effective, some people experience intolerable side effects that require other medications — either along with a low dose of corticosteroids, or instead of corticosteroids.
Corticosteroids may cause the following side effects, Cleveland Clinic notes:
Corticosteroids for polymyalgia rheumatica are taken by mouth. The most commonly prescribed drug is prednisone (Deltasone). A typical starting dose of prednisone for polymyalgia rheumatica is 10 to 15 milligrams (mg) daily, according to Cleveland Clinic.
Methotrexate is a drug that suppresses the immune system, and it's used to treat several forms of arthritis and related conditions. For some people with polymyalgia rheumatica, methotrexate is recommended along with corticosteroids.
This biologic drug belongs to a category known as anti-interleukin 6 agents (or IL-6 receptor blockers). It was approved for polymyalgia rheumatica in 2023 in the United States, and it may be used when corticosteroids are not effective or cannot be tolerated over time.
Sarilumab is given as an injection every two weeks for as long as needed to prevent PMR symptoms.
For some people, physical therapy for polymyalgia rheumatica may be beneficial and help you return to your everyday activities once you begin drug treatment. This is particularly true if your PMR previously left you unable to do certain activities, per Mayo Clinic — so you may have lasting muscle weakness from not using those muscles as you normally would.
Exercise, on the other hand, is important for everyone with polymyalgia rheumatica and can help maintain joint flexibility, muscle strength, and muscle coordination and function. The Arthritis Foundation suggests the following activities as good choices for people with PMR:
It’s also important to get enough rest, so that your joints and muscles can recover from exercise and everyday activities that may put an extra strain on them when you have PMR.
You should also avoid highly processed foods, including refined carbohydrates, and limit sources of unhealthy saturated fat like red meat and full-fat dairy products.
For some mild cases of polymyalgia rheumatica, taking a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil) or naproxen (Aleve) may be enough to control your symptoms, the Arthritis Foundation notes.
Don’t stop taking a prescription drug or switch to an over-the-counter NSAID just because your symptoms are gone — doing so may lead to a return of symptoms and complicate your treatment. Talk to your doctor if you’d like to explore changing your treatment because of corticosteroid side effects or any other reason.
Corticosteroids, the main drug treatment for polymyalgia rheumatica, can cause potentially serious side effects in a number of different areas. In some cases, your doctor may develop a treatment strategy that helps you minimize certain risks or side effects linked to these drugs.
While most people won’t need long-term treatment for PMR after about a year or two, it’s still important to keep long-term health risks in mind when developing a polymyalgia rheumatica management strategy.
Nearly everyone with polymyalgia rheumatica is initially prescribed corticosteroids as a treatment. While your dose of these drugs will be reduced over time, you may still develop side effects from them that may be bothersome or threaten other areas of your health.
Depending on your risk level for osteoporosis, your doctor may also monitor your bone density and prescribe medications to safeguard your bone health. To help prevent bone loss, your doctor may prescribe calcium and vitamin D supplements along with your corticosteroids. Typical doses are 1,000 to 1,200 mg of calcium and 600 to 800 international units (IU) of vitamin D daily, according to Mayo Clinic.
Mayo Clinic also notes that limiting sodium, including salt, in your diet may reduce fluid buildup and address high blood pressure linked to corticosteroid treatment.
Talk to your doctor if you experience unpleasant symptoms or disruption in your life while you’re taking corticosteroids, including any of the following issues, as identified by the Cleveland Clinic:
If corticosteroids are interfering with your quality of life, your doctor may be able to lower your dose and possibly add another medication to help keep you free of PMR symptoms.
The goals of polymyalgia rheumatica drug treatment, along with any lifestyle measures you take to address PMR, are to keep you symptom-free and prevent any long-term health problems. If you also have giant cell arteritis and are experiencing visual symptoms, it’s particularly important to get treatment right away to prevent any long-term vision loss.
Once you begin polymyalgia rheumatica treatment, you shouldn’t have to live with symptoms of the disease for very long. But PMR can still lead to daily difficulties, including lasting effects of the condition from before you started treatment, as well as disruptive medication side effects.
Adequate exercise and rest will minimize any pain or stiffness from PMR that you continue to experience, Mayo Clinic says. You may also benefit from the following adaptive strategies:
If you experience emotional difficulties related to polymyalgia rheumatica, it’s important to remember that you’re not alone in feeling the way you do — chronic health conditions can and do take a toll on many people’s mental health. You may benefit from the following strategies, as noted by the Vasculitis Foundation:
Talk to your doctor about getting a referral to a mental health professional if this is a treatment option that you would like to explore. Your doctor may know of resources in your area, including through your health system or insurance plan, that can help connect you with the care you need.
Depending on where you live, there may be an in-person support group in your area for people with polymyalgia rheumatica and related health conditions. There are also several online communities where you can connect with others to share experiences and give or receive support and advice.
Since polymyalgia rheumatica is highly treatable and usually goes away eventually, it may be difficult to find a local support group that’s aimed at people with the condition. You may find it easier to join a support group in your area for a broader range of health challenges, such as:
Talk to your doctor about whether there are any support groups in your area offered by healthcare providers or community organizations.
If there isn’t a relevant support group in your area or you’d prefer to connect with others virtually, there are online options that may offer some of the same benefits as in-person support groups.
The Arthritis Foundation offers video-based virtual support groups through what it calls a Live Yes! Connect Group. These groups are aimed at “all ages and stages of arthritis and related diseases,” and feature planned events led by Arthritis Foundation volunteers. To join a virtual event, you’ll need to create an Arthritis Foundation online account and register ahead of time.
For people with chronic pain, the U.S. Pain Foundation offers regular online support group meetings — including daily meetings open to anyone with chronic pain. There are also less frequent meetings aimed at people who live in a particular state or region, and groups including teenagers and Black, Indigenous, and People of Color (BIPOC) and LGBTQ+ communities.
Mayo Clinic has an online forum called Polymyalgia Rheumatica (PMR) Support Group, which offers answers and discussions on a variety of topics including prednisone and polymyalgia rheumatica (including side effects), living with PMR pain, calcium and other dietary supplements, exercise, and more. Even if you don’t actively participate in the forum, you may learn a lot by reading other people’s questions and answers.
While polymyalgia rheumatica can be highly distressing, most people respond quickly to treatment and eventually reach remission of the disease — meaning they have no active symptoms and don’t need to continue with treatment. While getting to remission can take years, once you begin treatment with corticosteroids, you may see your symptoms significantly improve within days to weeks.
Corticosteroid side effects, though, are a major challenge for many people living with PMR. Don’t hesitate to ask your doctor about how you should be monitored for problems like high blood pressure, diabetes, or osteoporosis. And if you find the side effects of corticosteroids to be extremely unpleasant or disruptive, ask about options for changing your treatment strategy to potentially reduce your dose of this type of drug.
With effective and personalized treatment, many people living with PMR can soon get back to doing what they enjoy — including exercise, recreation, and everyday activities — while keeping medication side effects to a minimum.
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