Treating polymyalgia rheumatica 

Steroid medication (corticosteroids) is the preferred treatment for polymyalgia rheumatica (PMR).

A type of corticosteroid called prednisolone is usually prescribed.

Prednisolone

Prednisolone works by blocking the effects of certain chemicals that cause inflammation inside your body. It doesn't cure polymyalgia rheumatica, but it can help relieve the symptoms.

When used to treat polymyalgia rheumatica, prednisolone is taken as a tablet. Most people will be prescribed several tablets to take once a day.

You'll be prescribed a high dose of prednisolone initially, and the dose will be gradually reduced every one to two months.

Although your symptoms should improve within a few days of starting treatment, you'll probably need to continue taking a low dose of prednisolone for about two years.

In many cases, polymyalgia rheumatica improves on its own after this time. However, there's a chance that the condition will return (relapse) once treatment stops.

Don't suddenly stop taking steroid medication unless a doctor in charge of your care tells you it's safe to do so. Suddenly stopping treatment with steroids can make you feel very ill.

Side effects of prednisolone

About one in 20 people who take prednisolone will experience changes in their mental state when they take the medication.

You may feel depressed and suicidal, anxious or confused. Some people also experience hallucinations (seeing or hearing things that aren't there). Contact your GP as soon as possible if you experience changes to your mental state. 

Other side effects of prednisolone include:

  • increased appetite that often leads to weight gain
  • increased blood pressure
  • mood changes, such as becoming aggressive or irritable with people
  • weakening of the bones (osteoporosis)
  • stomach ulcers 
  • increased risk of infection, particularly with the varicella-zoster virus (the virus that causes chickenpox and shingles

Seek immediate medical advice if you think you've been exposed to the varicella-zoster virus, or if a member of your household develops chickenpox or shingles.

The risk of these side effects should improve as your dose of prednisolone is decreased.

See side effects of corticosteroids for more information about how these side effects may affect you and how they're treated.

Other medications

Sometimes, other medicines may be combined with corticosteroids to help prevent relapses or to allow your dose of prednisolone to be reduced.

Some people are prescribed immunosuppressant medication, such as methotrexate. This is used to reduce or suppress the immune system (the body's defence against infection and illness). It may be helpful for people with polymyalgia rheumatica who have frequent relapses or don't respond to normal steroid treatment.

Your doctor may recommend painkillers, such as paracetamol, or non-steroidal anti-inflammatory drugs (NSAIDs), to help relieve pain and stiffness while your dose of prednisolone is reduced.

Follow-up

Your GP will ask you to attend regular follow-up appointments to check how well you're responding to treatment, whether your dose of prednisolone needs to be adjusted, and how well you're coping with the side effects of the medication.

During these appointments, you'll have blood tests to check the levels of inflammation inside your body.

Follow-up appointments are usually recommended every few weeks for the first three months and then at three- to six-monthly intervals after this time.

Contact your GP if your symptoms return during any part of your treatment. Your dosage may need to be adjusted.


Steroid card

If you need to take steroids for more than three weeks, your GP or pharmacist should arrange for you to be issued with a steroid card.

The card explains that you're regularly taking steroids and your dose shouldn't be stopped suddenly. You should carry the card with you at all times.  

Page last reviewed: 20/01/2015

Next review due: 20/01/2017