Treatment of polymyalgia rheumatica/giant cell arteritis

Corticosteroids control arteritis in GCA and suppress polymyalgic symptoms within days of starting treatment. PMR patients can be treated with approximately 15 mg prednisolone/day, reducing the dose to 7.5-10 mg by 8 weeks. GCA is normally controlled on 40 mg prednisolone/day, although patients with persistent visual symptoms may need 60-80 mg. Slow reduction to about 20 mg by 8 weeks should minimize relapses. For both PMR and GCA a maintenance dose of 7.5 mg after 6-9 months should be enough. Steroid withdrawal is possible within 2 years of starting treatment, although some will need 4 years or more. Relapse should be defined clinically; the ESR is the most useful laboratory parameter. Steroid side-effects can be minimized by using low doses of prednisolone whenever possible and azathioprine may be used as a steroid-sparing agent.