PMR is an inflammatory disease that causes achy joints and stiff muscles. The pain and stiffness can be severe enough to affect your daily life.
Medicines called corticosteroids, or steroids, relieve PMR pain quickly. But they don't work for everyone. It could take a few tries to find the dose that works for you. And you might need to add another medicine to see results.
Getting on the right medicine and staying on it can relieve your pain and help you get back to your regular activities.
Corticosteroids (Steroids)
Steroid medicines like prednisone (Deltasone, Orasone) are the first treatment for PMR. They come as pills. Steroids calm your immune system and lower inflammation.
This medicine works quickly. You should feel relief from pain and stiffness within a few days after you start taking steroids. But these drugs can cause side effects. Some of the most common ones are:
- Diabetes
- Weak bones (osteoporosis)
- High blood pressure
- Glaucoma
- Weight gain
Your doctor will put you on the lowest steroids dose needed to relieve your symptoms. Staying on a low dose will help you avoid side effects. If your symptoms come back often and you're at low risk for side effects, your doctor might start you on a higher steroid dose.
After a couple of months, if your symptoms get better, your doctor will lower the dose a little bit at a time. That's called a taper. You'll see your doctor every month or two for a symptom check and blood tests to measure inflammation in your body.
Steroids don't work for everyone who tries them. If they don't help with your symptoms or they cause side effects, your doctor might add another medicine or switch you to a different treatment.
Methotrexate
This is a common treatment for rheumatoid arthritis and other inflammatory types of arthritis. It calms your immune system to bring down inflammation. Your doctor might add methotrexate to steroids if your symptoms come back (relapse) or you have a lot of side effects from steroids.
Methotrexate is a “steroid-sparing” drug. That means you may be able to take a lower dose of steroids if you take methotrexate too.
This medicine can cause side effects like nausea, vomiting, tiredness, and mouth sores. Taking folic acid with methotrexate may help to prevent some of these problems.
Calcium and Vitamin D
Steroid medicines can weaken your bones and raise your chances of a fracture. If you have to stay on these medicines for 3 months or longer, your doctor might recommend that you take calcium and vitamin D supplements to keep your bones strong. And if you are at high risk for a fracture, you might also take medicines called bisphosphonates to slow bone loss.
NSAIDs
Doctors don't recommend nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen for PMR. That's because taking NSAIDs for a long time can cause side effects like stomach ulcers and heart problems.
These pain relievers may be OK to take for short periods of time for mild PMR, or to relieve pain from other conditions, like osteoarthritis.
Sarilumab (Kevzara)
Kevzara is the first biologic drug approved to treat PMR. It blocks the chemical interleukin-6 (IL-6), which causes inflammation. Your doctor might prescribe this medicine if your symptoms didn't improve on steroids or they came back when you tried to taper off steroids. Kevzara can help keep you in remission longer and take a lower steroid dose.
This medicine comes as a 200-milligram dose that you get through a needle under your skin. You take Kevzara once every 2 weeks while you taper off steroids or after you stop taking steroids.
Kevzara can sometimes cause side effects like these:
- Infections
- Itchy skin where you got the shot
- Low numbers of white blood cells
- High cholesterol
- Allergic reactions
- Liver damage
Don’t get live vaccines like measles, mumps, rubella (MMR), and chickenpox while you're on Kevzara. This medicine lowers your immune system. A live vaccine could make you sick.
Stay on Your Treatment Plan
Your symptoms should get better after a few days on treatment. But you may need to stay on polymyalgia treatment for a year or longer to prevent your symptoms from coming back.
Don't stop taking the medications, even if you feel better. Stopping could make your symptoms come back, which is called a relapse. If you have side effects, ask your doctor how to manage them.
You'll see your doctor often for check-ups during your treatment. The doctor will try to keep you on the lowest steroid dose needed to manage your symptoms. They can tell you when it's time for you to taper off your medicine.
Show Sources
Photo Credit: DigitalVision/Getty Images
SOURCES:
American College of Rheumatology: "Polymyalgia Rheumatica."
Annals of the Rheumatic Diseases: "FRI0475 Steroid Sparing Agents in Polymyalgia Rheumatica: A Systematic Review."
Arthritis Foundation: "Methotrexate: Managing Side Effects."
Arthritis & Rheumatology: "2015 Recommendations for the Management of Polymyalgia Rheumatica."
FDA: "Highlights of Prescribing Information: Kevzara."
Mayo Clinic: "Polymyalgia Rheumatica."
National Health Service (U.K.): "Corticosteroids," "Treatment: Polymyalgia Rheumatica."
StatPearls: "Polymyalgia Rheumatica."
The New England Journal of Medicine: "Sarilumab for Relapse of Polymyalgia Rheumatica During Glucocorticoid Taper."
