Diagnosis and treatment of PMR

PMR: polymyalgia rheumatica; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; GCA: giant cell arteritis.
* A current or prior diagnosis of GCA can support the diagnosis of PMR.
¶ A high ESR and/or CRP can support the diagnosis of PMR. Low or normal values do not exclude the diagnosis of PMR. Refer to UpToDate content for additional details regarding laboratory data in PMR.
Δ GCA can occur before, concurrent with, or after the diagnosis of PMR. All patients with PMR should be carefully assessed for symptoms and signs of GCA at initial diagnosis and then routinely screened for underlying GCA at subsequent visits. Any patient who develops sudden vision loss during treatment requires high-dose glucocorticoid treatment. Refer to UpToDate content on the diagnosis and management of GCA.
◊ The starting dose of prednisone can be modified depending on the patient's weight, severity of symptoms, and comorbidities (eg, diabetes, heart failure). Lower doses of prednisone (eg, 7.5 mg to 10 mg/day) may be appropriate in some patients, while higher doses of prednisone (maximum of 25 mg/day) may be necessary for others.
§ Diagnosis of PMR requires ongoing evaluation and exclusion of mimicking conditions during the follow-up period.
¥ Reduce prednisone (or equivalent) dose by 2.5 mg/day every 2 to 4 weeks until a dose of 10 mg/day achieved. Then reduce prednisone (or equivalent) dose by 1 mg/day every 1 to 2 months until discontinuation. Refer to UpToDate topic on the treatment of PMR.