Therapy of Polymyalgia Rheumatica and Giant Cell Arteritis

Abstract

Polymyalgia rheumatica and giant cell arteritis (PMR a GCA) are undoubtedly diseases with exceptionally good response to glucocorticoid treatment. Significant improvement after the administration of glucocortioids can be seen within 48 hours after the treatment is started. However, it is necessary to observe all the principles required for glucocorticoid treatment. Glucocorticoid daily dose normally does not exceed 15 mg, but the potential of a lower initial dose has been also reported. On the other hand, some authors consider a 10 mg dose insufficient as they needed the dose of 15–20 mg to keep the disease in remission. The goal of treatment is to reach at least partial remission within the first 4 weeks of the disease. The effect of treatment is evaluated after the first month of treatment. The clinical prednisone dose is most often decreased by 2.5 mg every 4 weeks. Doses of 5 to 7.5 mg of prednisone should be used as maintaining doses and patients should receive them at least for 12 months. In some patients, it is necessary to continue usually for 2 years, or 4 to 5 years in some cases. It is necessary to note that the positive effect of glucocorticoids can be limited by their adverse effects. Daily doses not exceeding 5 mg are relatively safe. However, the situation is different with PMR as we expect the administration of glucocorticoids taking more than 6 months with doses exceeding 5 mg. Therefore, it is necessary to use the appropriate complex examination, including bone densitometry, and to observe the respective laboratory parameters to monitor the appearance of osteoporosis. Prophylactic calcium and vitamin-D therapy, as well as biphosphonate therapy in appropriate cases, is also important.