Polymyalgia Rheumatica Medication

  • Author: Patricia J Papadopoulos, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Apr 4, 2012
 

Medication Summary

The goals of therapy in polymyalgia rheumatica are to control painful myalgia, to improve muscle stiffness, and to resolve constitutional features of the disease. Oral corticosteroids are the first line of treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful as adjuncts to corticosteroids during tapering, or alone in mild cases; however, because they are associated with increased drug-related morbidity, they should be used with caution in this elderly population.

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Corticosteroids

Class Summary

These agents cause profound and varied metabolic effects. Their exact mechanism of action in polymyalgia rheumatica is not well known, but their efficacy may stem from their general anti-inflammatory and immunomodulatory effects. In addition, corticosteroids down-regulate cytokine production.

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Prednisone

 

Prednisone has the capacity to dramatically reduce inflammatory manifestations for the following reasons:

  • Inhibition of the function of leukocytes and tissue macrophages, which diminishes their ability to respond to antigens and mitogens
  • Inhibition of phospholipase A2, resulting in decreased prostaglandin and leukotriene synthesis
  • Inhibition of cyclooxygenase II expression, which may be the enzyme more involved in the inflammatory effects of eicosanoids
  • Decreased activity of kinins and decreased histamine release by basophils, leading to decreased capillary permeability.

Polymyalgia rheumatica is rapidly responsive to low doses of prednisone. However, patients may require treatment for several months to several years.

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Nonsteroidal Anti-Inflammatory Drugs

Class Summary

These agents can be administered to some patients with mild symptoms; however, patients require corticosteroids for total control of symptoms. NSAIDs may be helpful in later stages of corticosteroid dosage tapering, with close monitoring for drug-related morbidity. NSAIDs generally have no effect on the erythrocyte sedimentation rate (ESR).[20]

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Ibuprofen (I-Prin, Motrin, Caldolor, NeoProfen, Proprinal)

 

Ibuprofen is the drug of choice for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Naproxen (Anaprox, Aleve, Naprosyn, Naprelan)

 

Naproxen is indicated for relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

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Antineoplastics, Antimetabolite

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Methotrexate (Trexall, Rheumatrex)

 

Antineoplastic agent that is immunosuppressive at lower doses. Antirheumatic effects may take several weeks to become apparent. Unknown mechanism of action in treatment of inflammatory disorders; may affect immune function. Ameliorates symptoms of inflammation (eg, pain, swelling, stiffness).

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Contributor Information and Disclosures
Author

Patricia J Papadopoulos, MD  Key Clinical Faculty, Rheumatology Service, Department of Medicine, Walter Reed National Military Medical Center; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

Patricia J Papadopoulos, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and American College of Rheumatology

Disclosure: Merck Ownership interest Own stock

Coauthor(s)

Ehab R Saad, MD, MA, FACP, FASN  Assistant Professor, Department of Medicine, Medical College of Wisconsin

Ehab R Saad, MD, MA, FACP, FASN 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.

Gloria Fioravanti, DO  Clinical Assistant Professor, Program Director, Department of Internal Medicine, St 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.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh 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: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

Additional Contributors

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the US Government. Additionally, this publication does not imply the Federal or Department of Defense endorsement of any product.

Past Contributors

Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Gino A Farina, MD, FACEP, FAAEM Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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.

Kristine M Lohr, MD, MS Professor, Department of Internal Medicine, Center for the Advancement of Women's Health and Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine

Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Nothing to disclose.

Geofrey Nochimson, MD Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital

Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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