Treatment of polymyalgia rheumatica

Area of Science:

• Rheumatology
• Immunology
• Internal Medicine

Background:

• Polymyalgia rheumatica (PMR) is a common inflammatory disorder affecting individuals over 50.
• Characterized by pain and stiffness in the shoulders, neck, and pelvic girdle.
• PMR management traditionally relies on glucocorticoids, often leading to long-term side effects.

Purpose of the Study:

• To review the epidemiology and clinical features of PMR.
• To discuss current and emerging therapeutic strategies for PMR management.
• To evaluate the efficacy of novel treatments in glucocorticoid-resistant or relapsing PMR.

Main Methods:

• Literature review of epidemiological data, clinical presentations, and treatment outcomes for PMR.
• Analysis of studies on conventional therapies, including glucocorticoids and methotrexate.
• Evaluation of evidence for biologic agents targeting inflammatory cytokines in PMR.

Main Results:

• PMR patients typically show rapid improvement with low-dose prednisone.
• Methotrexate offers modest benefits for glucocorticoid-sparing in some patients.
• Anti-tumor necrosis factor agents have not shown efficacy in PMR, but tocilizumab demonstrates potential in case series.

Conclusions:

• Glucocorticoids remain the cornerstone of PMR treatment, necessitating strategies to mitigate long-term toxicity.
• Tocilizumab shows promise for refractory PMR, but further controlled trials are required.
• The role of Janus-kinase inhibitors and other novel agents in PMR requires further investigation.