Polymyalgia Rheumatica.
Last updated Thursday, February 10, 2005
Management and treatmentHow is polymyalgia rheumatica treated? Treatment includes medications to help reduce inflammation as well as proper exercise and rest for some people in order to maintain joint flexibility, muscle strength, and function.
The goal in treating PMR is to help relieve pain, stiffness, and achiness. What medications are used to treat or manage polymyalgia rheumatica? Corticosteroid drugs,
strong medications that help reduce inflammation, are the usual
medications used to treat PMR. They also help relieve stiffness and
achiness. They act quickly in PMR. Most people feel better within a few
days or sometimes even the next day. There are many forms of
corticosteroids. For example, prednisone is a medication often used in
PMR.
If your doctor places you on a corticosteroid, you should follow
instructions carefully. Your doctor may have you take the entire dose
in the morning or have you divide the dose throughout the day. You
probably will feel better very soon after starting this medicine. It is
important to keep taking the medicine even though you are feeling
better. PMR can return if you stop this medicine too quickly. The usual
dose of prednisone is between 10 and 20 mg per day.
You may need to take corticosteroids as briefly as six months or as
long as one or two years. Some people may need to be treated even
longer. As you improve while on this medicine, it is likely that the
dose will slowly be decreased. Follow your doctor's instructions on how
often to take your medication. Do not try to cut back the dose on your
own or suddenly stop taking your medication, since your symptoms can
worsen.
Potential side effects of corticosteroids
Over a long period, corticosteroids may cause such side effects as:
- weight gain
- thinning of the bones (osteoporosis)
- depression and mood swings
- increased risk of infection
- cataracts
- glaucoma
- worsening of diabetes or new diabetes in someone who has never had it
- thinning of the skin and easy bruising
- rounding of the face
- difficulty sleeping
- high blood pressure (hypertension)
- avascular necrosis, an arthritis like condition that most commonly affects the hips or shoulders, and can be treated with total hip replacement or total shoulder replacement
These medications affect everyone differently. You may have some of
these side effects or none at all. If they do occur, most of these side
effects will go away when the medication is stopped or decreased. Your
doctor can give you some helpful tips about diet and exercise
to help with some of the side effects. If you are placed on this
medication, it is because your doctor feels that your symptoms are
serious enough to need this medication. Let your doctor know about any
side effects that you may be experiencing.
You'll need to see your doctor regularly once you start
taking medication. Tell your doctor how the medicine has affected your
symptoms. Report any side effects that you may have developed, such as
weight gain or depression. Your doctor may use various tests like the
ESR to adjust your medication. Even though you may feel well, it is
important to see your doctor regularly so you can be checked for any
signs of a relapse. Once you have responded to corticosteroids, the
goal is to slowly reduce the dose to the lowest level necessary to
control symptoms and prevent a relapse.
Special instructions for corticosteroids
Corticosteroids are different from many of the medications
you may have taken in the past. Your body naturally produces small
amounts of hormones that are forms of corticosteroids. When you take
corticosteroids for more than a few days, your body may stop producing
some of these hormones. This is not permanent. Your body gradually will
start making the hormones again as the dose of your medication is
lowered.
Your body depends on corticosteroids for many daily functions. These
hormones are important during times of stress. Your body does not care
whether it receives corticosteroids from natural hormones or from
medication. However, if you suddenly stop taking this medication, your
body may not make enough hormones on its own right away. This can make
you seriously ill. Also, your body's need for this medicine is greatest
in the morning. That is one reason why most people should take some or
all of the medicine in the morning.
Some important rules about corticosteroids are as follows:
- Do not stop this medication without discussing it with your doctor.
- Do
not try to decrease this medication on your own. You and your doctor
will need to work together to gradually wean you off of this medicine.
- Tell
your other doctors and other health professionals that you are taking
this medicine. In some cases, they may want to delay certain types of
treatments if you are taking corticosteroids. Your medication may need
to be increased for short periods of time if your body is under a lot
of stress--for example, if you are recovering from surgery or a serious
illness. Even after you have been off corticosteroids for as long as
one year, you should tell your doctor that you used to take them.
- Wear
medical identification to let people know that you take these
medications in case a medical emergency occurs. Should you be involved
in an accident or become seriously ill, it is very important that this
information be known. Also, tell your family that you are taking
corticosteroids so they can tell others in an emergency.
- If
you become ill and are unable to take this medication because of
vomiting, let your doctor know right away. You may need to increase
your usual dose for several days when you are sick.
Many of the side effects of corticosteroids are directly related to the
dose given. The therapeutic goal is to always find the lowest effective
dose that will avoid as many of the side effects as possible. You
probably will not need large doses of corticosteroids unless your PMR
is accompanied by giant cell arteritis. Serious side effects are much
less common with the low doses of corticosteroids usually used in PMR,
but it still is wise to follow these safety rules.
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