Clinical Rheumatology

, Volume 31, Issue 3, pp 575–579 | Cite as

Anti-TNF therapy for polymyalgia rheumatica: report of 99 cases and review of the literature

  • Nádia Emi Aikawa
  • Rosa Maria Rodrigues Pereira
  • Laís Lage
  • Eloisa Bonfá
  • Jozélio Freire CarvalhoEmail author
Case Based Review


The objective of this study was to analyze the clinical, laboratorial, and therapeutical response of polymyalgia rheumatica (PMR) to anti-tumor necrosis factor (anti-TNF) treatment. We systematically searched English articles on the subjects of PMR who were treated with TNF blockers in Pubmed from 1994 to 2010. In addition, we reported on two patients with PMR who were treated by the Rheumatology Division of the Hospital das Clínicas da Faculdade de Medicina da Universidade in São Paulo, Brazil. Ninety-nine cases of patients with PMR treated with anti-TNF were reviewed. The age of these patients ranged from 63 to 84 years, and 70.7% of them were female. Disease duration varied from 10.5 weeks to 95 months, and time of follow-up varied from 2 weeks to 21 months. Infliximab was the anti-TNF of choice in three studies, while etanercept was in five. Time to response varied from 2 to 8 weeks. After anti-TNF treatment, prednisone reduction was observed in all studies. Clinical improvement was found in 7/7 studies, and laboratory improvement of at least 50% of inflammatory markers was observed in 6/7 studies. This study demonstrated a good clinical and laboratory response to anti-TNF therapy in patients with PMR, with or without glucocorticoid.


Anti-TNF Etanercept Infliximab Polymyalgia rheumatica Vasculitis 



JF Carvalho, RM Pereira, and E Bonfa received grants from the Federico Foundation and CNPq (300665/2009-1 to JFC, 300559/2009-7 to RMRP, and 305468/2006-5 to EB).




  1. 1.
    Salvarani C, Cantini F, Hunder GG (2008) Polymyalgia rheumatica and giant cell arteritis. Lancet 372:234–245PubMedCrossRefGoogle Scholar
  2. 2.
    Salvarani C, Cantini F, Niccoli L, Catanoso MG, Macchioni P, Pulsatelli L et al (2003) Treatment of refractory polymyalgia rheumatica with infliximab: a pilot study. J Rheumatol 30:760–763PubMedGoogle Scholar
  3. 3.
    Ayoub WT, Franklin CM, Torretti D (1985) Polymyalgia rheumatica. Duration of therapy and long-term outcome. Am J Med 79:309–315PubMedCrossRefGoogle Scholar
  4. 4.
    Dasgupta B, Dolan AL, Panayi GS, Fernandes L (1998) An initially double-blind controlled 96 week trial of depot methylprednisolone against oral prednisolone in the treatment of polymyalgia rheumatica. Br J Rheumatol 37:189–195PubMedCrossRefGoogle Scholar
  5. 5.
    Cimmino MA, Parodi M, Caporali R, Montecucco C (2006) Is the course of steroid-treated polymyalgia rheumatica more severe in women? Ann N Y Acad Sci 1069:315–321PubMedCrossRefGoogle Scholar
  6. 6.
    van der Veen MJ, Dinant HJ, van Booma-Frankfort C, van Albada-Kuipers GA, Bijlsma JW (1996) Can methotrexate be used as a steroid sparing agent in the treatment of polymyalgia rheumatica and giant cell arteritis? Ann Rheum Dis 55:218–223PubMedCrossRefGoogle Scholar
  7. 7.
    Migliore A, Massafra U, Carloni E, Padalino C, Martin Martin S, Lasaracina F et al (2005) TNF-alpha blockade induce clinical remission in patients affected by polymyalgia rheumatica associated to diabetes mellitus and/or osteoporosis: a seven cases report. Eur Rev Med Pharmacol Sci 9:373–378PubMedGoogle Scholar
  8. 8.
    Salvarani C, Macchioni P, Manzini C, Paolazzi G, Trotta A, Manganelli P et al (2007) Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial. Ann Intern Med 146:631–639PubMedGoogle Scholar
  9. 9.
    Catanoso MG, Macchioni P, Boiardi L, Pipitone N, Salvarani C (2007) Treatment of refractory polymyalgia rheumatica with etanercept: an open pilot study. Arthritis Rheum 57:1514–1519PubMedCrossRefGoogle Scholar
  10. 10.
    Corrao S, Pistone G, Scaglione R, Colomba D, Calvo L, Licata G (2009) Fast recovery with etanercept in patients affected by polymyalgia rheumatica and decompensated diabetes: a case-series study. Clin Rheumatol 28:89–92PubMedCrossRefGoogle Scholar
  11. 11.
    Dasgupta B, Salvarani C, Schirmer M, Crowson CS, Maradit-Kremers H, Hutchings A, members of the American College of Rheumatology Work Group for Development of Classification Criteria for PMR et al (2008) Developing classification criteria for polymyalgia rheumatica: comparison of views from an expert panel and wider survey. J Rheumatol 35:270–277PubMedGoogle Scholar
  12. 12.
    Salvarani C, Macchioni P, Boiardi L (1997) Polymyalgia rheumatica. Lancet 350:43–47PubMedCrossRefGoogle Scholar
  13. 13.
    Kyle V, Hazelman BL (1990) Stopping steroids in polymyalgia rheumatica and giant cell arteritis. BMJ 300:344–345PubMedCrossRefGoogle Scholar
  14. 14.
    Cutolo M, Montecucco CM, Cavagna L, Caporali R, Capellino S, Montagna P et al (2006) Serum cytokines and steroidal hormones in polymyalgia rheumatica and elderly-onset rheumatoid arthritis. Ann Rheum Dis 65:1438–1443PubMedCrossRefGoogle Scholar
  15. 15.
    Kreiner F, Galbo H (2010) Effect of etanercept in polymyalgia rheumatica: a randomized controlled trial. Arthritis Res Ther 12:R176PubMedCrossRefGoogle Scholar
  16. 16.
    Salvarani C, Cantini F, Boiardi L, Hunder GG (2002) Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 347:261–271PubMedCrossRefGoogle Scholar
  17. 17.
    Dasgupta B, Borg FA, Hassan N, Barraclough K, Bourke B, Fulcher J et al (2010) BSR and BHPR standards, guidelines and audit Working Group. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford) 49:186–190CrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2012

Authors and Affiliations

  • Nádia Emi Aikawa
    • 1
  • Rosa Maria Rodrigues Pereira
    • 1
  • Laís Lage
    • 1
  • Eloisa Bonfá
    • 1
  • Jozélio Freire Carvalho
    • 1
    Email author
  1. 1.Rheumatology DivisionHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil

Personalised recommendations