Health
What Is Polymyalgia Rheumatica? Symptoms, Causes, Diagnosis, and Treatment
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The goal of treatment for polymyalgia rheumatica is to relieve your symptoms, especially pain and stiffness. The standard treatment is a group of drugs called corticosteroids (also known simply as steroids), but there are other treatment options if your condition doesn’t respond well to steroids or you experience intolerable side effects.
Medications
Polymyalgia rheumatica typically responds well to treatment with corticosteroids, a group of anti-inflammatory medications. These drugs are taken by mouth at the lowest possible dose to help reduce the risk for side effects. Current recommendations are for a starting dose of prednisolone between 12.5 and 25 milligrams daily.
Once your polymyalgia rheumatica symptoms are under control, it’s common for your doctor to gradually reduce your dose of corticosteroids until you reach a very low maintenance dose that you may take for a year or longer.
Potential side effects of corticosteroids include increased appetite, weight gain, type 2 diabetes, and osteoporosis (weak and brittle bones).
Weight gain most often happens in people who take higher doses or longer courses of corticosteroids. If you gain weight while on corticosteroids, you’ll likely find it easier to lose the weight 6 to 12 months after you stop taking them.
While taking corticosteroids, strategies like exercising and eating a nutritious diet rich in fruits, vegetables, fiber-rich carbohydrates, and proteins can help minimize weight gain as much as possible. It may also help to eat six small meals throughout the day instead of three large ones, especially if your appetite has increased while on corticosteroids.
It’s important for your doctor to measure your glucose level when you start corticosteroids and monitor it while you’re taking them so you can start on insulin or oral drugs to lower your glucose level if it goes and stays too high. Your doctor may also teach you how to self-monitor your glucose level each day.
If you experience unpleasant side effects from corticosteroids, or if your symptoms aren’t adequately controlled by this treatment, your doctor may consider prescribing the following drugs:
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs) This group of medications includes drugs approved for other conditions that help reduce inflammation at the cellular level, such as the immune-suppressing drug methotrexate. Your doctor may prescribe DMARDs along with corticosteroids to help reduce your corticosteroid dose or to address episodes of worsening polymyalgia rheumatica symptoms, according to NIAMS.
- Sarilumab (Kevzara) This biologic medication was approved in 2023 in the United States to treat polymyalgia rheumatica in people who don’t respond adequately to corticosteroids or who can’t tolerate long-term corticosteroid use. Sarilumab is given as an injection every two weeks for as long as needed.
Some people with mild polymyalgia rheumatica and only those who don’t have any symptoms of giant cell arteritis such as headache, jaw pain, or vision loss may respond well to over-the-counter nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen.
These drugs typically have fewer undesirable side effects than corticosteroids, but they’re not effective for many people.
Physical Therapy
Most people with polymyalgia rheumatica can return to their regular daily activities once they start taking a corticosteroid or another effective treatment. But if your movement has been limited for a long time, you may benefit from physical therapy; talk to your doctor about this option.
Complementary and Alternative Treatments
Along with taking medications as prescribed, it’s important to pay attention to both exercise and rest as part of your polymyalgia rheumatica treatment. Regular exercise helps maintain joint flexibility and muscle strength, both of which can help reduce the burden of polymyalgia rheumatica symptoms. Potentially helpful forms of exercise include:
Getting enough rest and sleep can help make sure that your body recovers from exercise and daily activities, which may help limit inflammation.
Following a healthy diet can also help reduce inflammation and potentially help reduce side effects of corticosteroids. Eat plenty of fruits, vegetables, whole grains, and lean sources of protein and dairy. If you’re taking a corticosteroid, limiting sodium (including salt) in your diet can help prevent fluid buildup and high blood pressure.
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