If you are diagnosed with polymyalgia rheumatica, it is very important that you get treatment. If you don’t, symptoms will get worse and make it harder for you to do all your daily activities like bathing, dressing, and getting in and out of your car. It may also make you more likely to develop giant cell arteritis (GCA), which is an inflammation of your aorta, one of your heart arteries.
There are several effective treatments available for this condition. They do have side effects to be aware of, but most of the time, you and your doctor can manage them. Here are the ones to look for:
What Are the Side Effects of Glucocorticoids?
These medications are generally the first treatment for polymyalgia rheumatica. The two main drugs used are prednisone or prednisolone. You’ll be given a moderate to low dose (10 to 15 milligrams) as a tablet each day. If your symptoms don’t respond within about a week, you may be given a higher dose. Once your symptoms have improved, your doctor will begin to taper the dose by lowering it every 2 to 4 weeks.
Side effects of this type of medicine include:
Bone loss. This usually happens within the first 6 months of treatment and slows after about a year.
If you are going to be on one of these steroids for more than 3 months, it’s very important that you talk to your doctor about bone loss. They should do a bone scan to check your bone density before you begin treatment. To lower your risk of bone loss, your doctor may recommend:
Calcium and vitamin D. You’ll need to get 800 to 1,200 milligrams of calcium daily, as well as 800-2,000 IU of vitamin D. You can get calcium from foods such as dairy products and leafy greens like kale, bok choy, and spinach. Most of the vitamin D we get comes from fortified foods, including dairy, breakfast cereals, and orange juice. You can also take a supplement.
Lifestyle changes. Your doctor will want you to limit alcohol, get regular exercise, and stop smoking.
Osteoporosis medications. These drugs, known as bisphosphonates, both treat and prevent bone loss. Your doctor may recommend that you take them if you are a man or woman over the age of 50, or your bone scan shows that you have low bone density.
As long as you stay on steroid treatment, you should have bone scans once a year.
GI upset. Steroids increase your risk of peptic ulcers or GI bleeding, especially if you also take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin. Your doctor may want you to take another type of drug, known as a proton pump inhibitor (such as Prevacid), to reduce the risk of ulcers.
High blood sugar. Glucocorticoids help your body maintain normal levels of glucose, or sugar, in your blood. If you’re on these drugs for a while, they can raise your blood sugar and even lead to type 2 diabetes. Your doctor will want to check your blood glucose levels before treatment, and then on a regular basis while you’re on steroids.
Eye problems. Glucocorticoids can sometimes cause cataracts or increased eye pressure (glaucoma). Your doctor may want you to see an ophthalmologist, or eye doctor, throughout your treatment to watch you for these two conditions.
Increased blood pressure and cholesterol. At high doses, glucocorticoids can raise your blood pressure. This is because they cause your body to get rid of substances such as potassium, calcium, and phosphate, which help keep blood pressure in check. They can also cause you to gain weight. Your doctor will want to check your blood pressure at every visit and keep tabs on your cholesterol levels.
Risk of infections. Glucocorticoids can tamp down your immune system. This makes it harder for your body to fight off viruses and bacteria. Your doctor will want to make sure you’re up to date on all your vaccines before you start treatment.
Mood changes. Some people feel euphoria, or a heightened sense of well-being, when they start glucocorticoids. Others feel anxious. The longer you are on them, the more likely these emotions are to turn to depression. You may also have trouble sleeping. Let your doctor know if you have a history of mood disorders such as depression. You should also alert them to any changes in mood. They may want to refer you to a psychiatrist to screen you for depression and treat it if needed.
What Are the Side Effects of Methotrexate?
Sometimes, your doctor will recommend that you take a drug called methotrexate along with glucocorticoids. They may suggest this if your PMR has come back, or if you already have conditions such as osteoporosis or type 2 diabetes. This drug can cause side effects like:
- Nausea
- Vomiting
- Loss of appetite
- Mouth ulcers
The good news is many of these side effects can be avoided if you take a folic acid supplement. Your doctor may suggest that you:
- Split the dose. Take half in the morning and half at night.
- Take anti-nausea medications, such as ondansetron (Zofran).
- Take the medication as a shot instead of a pill.
- Try a mouth rinse. You can use saltwater or a rinse that contains lidocaine as a pain reliever.
What Are the Side Effects of Sarilumab?
Also known as Kevzara, this is a second-line therapy. This means that you take it if you didn’t respond to glucocorticoids, or if you had trouble getting off them. If you take it, you may notice the following side effects:
Low white blood cell and platelet counts. These cells help your body fight infection and stop bleeding. Your doctor will check levels 4 to 8 weeks after you start treatment, and then every 3 months afterward.
Liver changes. Kevzara can cause temporary changes to your liver. Your doctor will check your liver function a month or two after you start the drug, and then every 3 months going forward. If you do have any abnormal liver tests, your doctor may decide to change your dose, or even stop the medicine for a period of time.
Elevated cholesterol. Kevzara can raise levels of your LDL, or bad cholesterol, as well as your triglycerides. Your doctor will want to check this when they check your blood cell count and liver function. If your cholesterol is higher than normal, they can talk to you about steps to lower it, such as taking medication.
Lowered immune system. Your doctor should test you for tuberculosis before you start Kevzara. If you do have any signs of an infection while you are on Kevzara, such as a fever, chills, muscle aches or coughing, let your doctor know right away.
Tears in your stomach or intestine. This is a very rare but serious side effect. You may be more at risk if you already use NSAIDs or steroids. Call your doctor right away if you have a fever and stomach pain.
Remember, not everyone will notice side effects from these drugs. But they can happen, and they can develop slowly over time, which is why it’s so important to stay in close touch with your doctor. This way, they can not only track your progress with treatment, but also manage any side effects.
Show Sources
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SOURCES:
Cleveland Clinic: “Polymyalgia Rheumatica.”
UpToDate: “Treatment of Polymyalgia Rheumatica.”
Journal of the American Academy of Dermatology: “Prevention and Management of Glucocorticoid-Induced Side Effects: A Comprehensive Review.”
MyHealthfinder: “Calcium: Shopping List.”
National Institutes of Health, Office of Dietary Supplements: “Vitamin D.”
National Library of Medicine: “Corticosteroid Adverse Effects.”
Arthritis Foundation: “Methotrexate: Managing Side Effects.”
Specialist Pharmacy Service: “Using folic acid with methotrexate in rheumatoid arthritis.”
Sanofi: “KEVZARA: Prescribing Information.”
