eMedicine Specialties > Rheumatology > Vasculitis

Polymyalgia Rheumatica: Follow-up

Author: Ehab R Saad, MD, FACP, FASN, MA, Assistant Professor, Department of Medicine, Medical College of Wisconsin
Coauthor(s): Gloria Fioravanti, DO, Program Director, Clinical Assistant Professor, Department of Internal Medicine, Saint Luke's Hospital of Bethlehem, Temple University School of Medicine; Allen Samuels, MD, Consulting Staff, Department of Internal Medicine, Division of Rheumatology, St Luke's Hospital, Lehigh Valley Hospital, Pocono Medical Center
Contributor Information and Disclosures

Updated: Aug 20, 2009

Follow-up

Further Outpatient Care

  • Polymyalgia rheumatica is typically treated in an outpatient setting. Objective means of determining prognosis and decisions concerning duration of treatment remain empiric and often need careful supervision.
  • Calcium and vitamin D supplementation should be initiated in all patients with polymyalgia rheumatica who are starting corticosteroid therapy. Osteopenia or osteoporosis discovered with a bone mineral density study (eg, dual-energy x-ray absorptiometry [DEXA] scan) is an indication to start antiresorptive therapy.
  • An isolated increase of ESR without symptoms during the course of treatment is not a valid reason to increase corticosteroid dose; however, a temporary delay in dosage reduction may be necessary.
  • Because relapses are more likely to occur during the initial 18 months of therapy and within 1 year of corticosteroid withdrawal, all patients should be monitored for symptom recurrence throughout corticosteroid tapering and until 12 months after cessation of therapy.
  • Approximately 50-75% of patients can discontinue corticosteroid therapy after 2 years of treatment.

Inpatient & Outpatient Medications

  • If not contraindicated, NSAIDs may provide supplemental pain relief. They may be used alone in the treatment of patients with mild symptoms.
  • Methotrexate and other immunosuppressive therapies are seldom used in polymyalgia rheumatica treatment. Occasionally, they may be considered in patients with corticosteroid intolerance or as corticosteroid-sparing agents.

Deterrence/Prevention

  • No method or strategy is known to be effective in preventing polymyalgia rheumatica.

Complications

  • Polymyalgia rheumatica usually has a limited course of several months to 5 years. Untreated patients often feel unwell and have an impaired quality of life.
  • Generally, polymyalgia rheumatica is not associated with serious complications.
  • Patients treated with corticosteroids are at risk for long-term complications of corticosteroid therapy.
  • Relapses are common and may occur in up to 25% of all treated patients. Arteritic relapse in a patient who presented exclusively with polymyalgia rheumatica is unusual.
  • Every patient should be considered at risk for giant cell arteritis.
  • Several cases of systemic amyloidosis-associated polymyalgia rheumatica have been reported.7

Prognosis

  • Polymyalgia rheumatica is usually self-limited. With prompt diagnosis and adequate therapy, the condition has an excellent prognosis.

Patient Education

  • Inform the patient about the potential benefits and risks of corticosteroid treatment and encourage the patient to participate in choosing the treatment plan.
  • Emphasize the importance of healthy dietary habits and ensure adequate calcium and vitamin D supplementation.
  • Emphasize compliance with long-term treatment plans and follow-up care in order to prevent relapses, flares, and subsequent morbidity secondary to corticosteroid therapy.
  • Advise patients to immediately seek medical care if symptoms recur.
  • For excellent patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education article Chronic Fatigue Syndrome.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider giant cell arteritis in atypical cases of polymyalgia rheumatica
  • Failure to consider alternative causes of systemic illness with an elevated ESR
  • Failure to fully inform the patient about potential risks secondary to prolonged corticosteroid therapy
  • Failure to arrange timely follow-up care

Special Concerns

  • Patients with polymyalgia rheumatica should be monitored regularly and carefully for symptoms and signs suggestive of giant cell arteritis development.
 


More on Polymyalgia Rheumatica

Overview: Polymyalgia Rheumatica
Differential Diagnoses & Workup: Polymyalgia Rheumatica
Treatment & Medication: Polymyalgia Rheumatica
Follow-up: Polymyalgia Rheumatica
References
Further Reading
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Keywords

polymyalgia rheumatica, PMR, giant cell arteritis, GCA, collagen diseases, muscle pain, morning stiffness, HLA-DR4, interleukin-2, IL-2, interleukin-6, IL-6, remitting seronegative symmetrical synovitis with pitting edema, RS3PE, carpal tunnel syndrome, malaise, fatigue, depression, nonerosive synovitis, tenosynovitis, bursitis, proximal myalgia of the hip, shoulder girdles, HLA-DR4 haplotype

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Contributor Information and Disclosures

Author

Ehab R Saad, MD, FACP, FASN, MA, Assistant Professor, Department of Medicine, Medical College of Wisconsin
Ehab R Saad, MD, FACP, FASN, MA is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Geriatrics Society, American Society of Nephrology, and National Kidney Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Gloria Fioravanti, DO, Program Director, Clinical Assistant Professor, Department of Internal Medicine, Saint Luke's Hospital of Bethlehem, Temple University School of Medicine
Gloria Fioravanti, DO is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Osteopathic Association
Disclosure: Nothing to disclose.

Allen Samuels, MD, Consulting Staff, Department of Internal Medicine, Division of Rheumatology, St Luke's Hospital, Lehigh Valley Hospital, Pocono Medical Center
Allen Samuels, MD is a member of the following medical societies: American College of Rheumatology
Disclosure: Nothing to disclose.

Medical Editor

Kristine M Lohr, MD, MS, Program Director, Professor, Department of Internal Medicine, Division of Rheumatology and Women's Health, University of Kentucky School of Medicine
Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and American Medical Women's Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Elliot Goldberg, MD, Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
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