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Small-Molecule Strategies for Polymyalgia Rheumatica and Giant Cell Arteritis in Older Adults.
Jan Kurdybacha1, Oleksii Kravets1, Natalia Lekston1
1Students' Scientific Society, Department of Rheumatology and Clinical Immunology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland.
Molecules (Basel, Switzerland)
|July 15, 2026
Summary
New small-molecule drugs offer safer, steroid-sparing treatments for polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). Janus kinase inhibitors (JAKi) show promise in reducing glucocorticoid dependence and managing these inflammatory conditions in older adults.
Area of Science:
- Rheumatology
- Immunology
- Geriatrics
Background:
- Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are age-related inflammatory diseases.
- Long-term glucocorticoid (GC) therapy carries significant risks for older adults.
Purpose of the Study:
- To review the rationale and efficacy of small-molecule drugs as steroid-sparing agents for PMR and GCA.
- To evaluate Janus kinase inhibitors (JAKi) and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).
Main Methods:
- Critical evaluation of pathophysiological mechanisms.
- Analysis of clinical evidence for JAK inhibitors and csDMARDs.
- Review of novel therapeutic approaches.
Main Results:
- JAK inhibitors (upadacitinib, tofacitinib, baricitinib) show potential for remission and reduced GC burden in GCA and PMR.
- Methotrexate has modest efficacy and is a secondary option.
- Novel therapies may reverse GC-induced morbidities.
Conclusions:
- Targeted small-molecule immunomodulators represent a key therapeutic strategy for PMR and GCA.
- These agents aim to maximize remission while minimizing GC toxicity in geriatric patients.
- Safer alternatives to long-term GC therapy are crucial for managing these inflammatory conditions.
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