Polymyalgia rheumatica (PMR)

Written by Dr Badal Pal, consultant rheumatologist

Is there any other treatment available for PMR?
Yes, but it is only used in patients when it becomes difficult to reduce the prednisolone after prolonged high dosages, eg 10mg or more per day for more than a year or two. In this situation, doctors prescribe 'steroid sparing drugs' such as azathioprine or methotrexate. These can be used along with the prednisolone initially, but with a view to slowly reduce and withdraw prednisolone to avoid side effects. Then, either methotrexate or azathioprine can take over the action of the corticosteroids to keep the inflammation suppressed. Azathioprine or methotrexate will be discontinued if there has been sufficient response.

What side effects can I expect from prednisolone?

Weight gain, especially around the abdomen, with a puffy face ('moon face').

Easy bruising of the skin, sometimes with little or no trauma, such as on the back of the hands.

Some patients lose a little hair.

Older patients, or those with a diagnosis of underlying diabetes, may experience rises in their blood sugar and the doctor will need to check the blood sugar.

There may be a slight rise in blood pressure and those with a known diagnosis of high blood pressure (hypertension) need to have their blood pressure checked regularly.

Bones can also become thinner (osteoporosis), but this can be countered by preventative treatment with calcium and vitamin D, hormone replacement therapy (HRT) or certain other drugs called bisphosphonates (Fosamax, Didronel or Actonel), depending on patients' circumstances.

All patients on corticosteroids should have their bone strength measured by a process known as bone densitometry (DEXA).

Caution! Patients on corticosteroids should not stop their medication suddenly as this can lead to harm. They should always carry a 'blue steroid card' that can be obtained either from their doctor or pharmacist. This will alert doctors in case of any unforeseen circumstances such as accident or illness, as temporarily the dose of corticosteroids may need to be increased in such a situation.

Are there any other types of corticosteroids that can be used?
A relatively new type of steroid called deflazacort is available, but doctors generally feel it does not have advantages over prednisolone in routine practice, except perhaps in diabetics where blood sugar control is less affected with deflazacort than with ordinary prednisolone.

<<Go To Page 1

The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care or attention by a qualified practitioner. The materials in this web site cannot and should not be used as a basis for diagnosis or choice of treatment. Conditions for use



© Copyright 1998 - 2004 NetDoctor.co.uk - All rights reserved