Steroid medication (corticosteroids) is the preferred treatment for polymyalgia rheumatica. A type of corticosteroid called prednisolone is usually prescribed.
Non-steroidal anti-inflammatory drugs (NSAIDs), which are widely used to treat other inflammatory conditions, only have limited effectiveness in treating polymyalgia rheumatica. Therefore, there is currently no effective alternative medication for treating the condition other than steroids.Your doctor may use another medicine to help reduce the amount of steroid you need: the most commonly used are methotrexate or azathioprine.
Prednisolone works by blocking the effects of certain chemicals that are responsible for kick-starting the process of inflammation inside your body. It is taken orally. Most people will be prescribed several tablets, once a day.
It is likely that you will be prescribed about four 5mg prednisolone tablets initially, and the dosage will be gradually reduced every one to two months.
You may need to take prednisolone for at least two years to prevent the symptoms of polymyalgia rheumatica returning. There should be a marked improvement in symptoms within a few days of starting treatment.
Do not stop taking your steroid medication unless your GP says that it is safe for you to do so. This is because suddenly stopping steroid treatment can make you feel very ill.
Side effects of prednisolone include:
- increased appetite that often leads to weight gain
- thinning of the bones (osteoporosis)
- increased blood pressure
- increased blood sugar (diabetes)
- increased risk of infection
These side effects should improve as your dosage of prednisolone is decreased, although osteoporosis can be a persistent problem, particularly if you are over 65. It can put you at increased risk of fracturing a bone.
To reduce the risk of osteoporosis, your GP will usually also prescribe medication (bisphosphonates) and calcium and vitamin D supplements to help compensate for the effects of prednisolone by strengthening your bones. Read more about the treatment of osteoporosis
You may also be referred for a scan known as a dual energy X-ray absorptiometry (DEXA) scan, which helps assess how strong your bones are (see diagnosing osteoporosis)
Vulnerability to infection
Prednisolone can also make you more vulnerable to infection, particularly to the varicella-zoster virus, which is the virus that causes chickenpox and shingles.
You may become very ill if you develop these viral infections. Therefore, avoid close contact with anyone who has chickenpox or shingles.
Seek immediate medical advice if you think that you have been exposed to one of these infections or if a member of your household develops one of these infections.
Your GP will ask you to attend regular follow-up appointments so that they can check how well you are responding to treatment, whether your dosage of prednisolone needs to be adjusted and how well you are coping with the side effects of the medication.
During these appointments, you will 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.
If you experience a return of your symptoms during any part of your treatment, contact your GP because your dosage may need to be adjusted.