Polymyalgia arteritica: a clinical review.

Area of Science:

• Rheumatology
• Internal Medicine

Background:

• Polymyalgia arteritica encompasses polymyalgia rheumatica and cranial arteritis.
• Initial low-dose prednisolone may be insufficient for some patients.

Purpose of the Study:

• To evaluate the efficacy of initial prednisolone dosing in polymyalgia arteritica.
• To investigate factors contributing to symptomatic relapses and assess long-term treatment strategies.

Main Methods:

• Retrospective analysis of 37 consecutive polymyalgia arteritica patients.
• Dosage adjustments and monitoring of erythrocyte sedimentation rate (ESR).
• Assessment of relapse triggers and treatment outcomes.

Main Results:

• Twenty-five patients had polymyalgia rheumatica, twelve had cranial arteritis.
• Initial dose of 40 mg daily prednisolone recommended due to poor response to lower doses.
• Four patients had elevated ESR at 3 months, with three diagnosed with rheumatoid disease and one with pulmonary tuberculosis.
• Fourteen patients experienced 21 relapses, all responding to increased prednisolone.
• Most relapses occurred within the first year due to rapid steroid reduction.
• Relapses on stable doses were linked to rheumatoid disease development.
• Long-term prednisolone therapy deemed justifiable for elderly patients with relapses or arteritic complications.

Conclusions:

• An initial daily dose of 40 mg prednisolone is recommended for polymyalgia arteritica.
• Careful steroid tapering is crucial to prevent relapses.
• Long-term prednisolone therapy is a viable option for specific patient groups.