How are polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) treated?
There is no known cure for PMR and GCA, but these diseases can be treated and controlled.
Corticosteroids- Corticosteroid treatment helps rapidly relieve symptoms of both PMR and GCA. Treatment with corticosteroids is mandatory for GCA to prevent serious vascular complications such as blindness. Low doses of corticosteroids are often successful in treating PMR. Higher doses are often required to control GCA.
The excellent response to treatment is so uniform that the lack of dramatic improvement, within days, would make the diagnosis of GCA or PMR doubtful.
Corticosteroids (or "steroids") are man-made drugs that closely resemble cortisol, a hormone that your adrenal glands produce naturally. Some corticosteroid medications are cortisone, prednisone, and methylprednisolone. Prednisone is the most common steroid used to treat certain rheumatic diseases.
Steroids reduce the numbers of inflammatory cells and chemicals that cause these illnesses. Consequently, steroids minimize tissue damage. Steroids also reduce the normal activity of the immune system by affecting the protective functions of white blood cells.
The decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, presence of other illnesses, and medications you are taking. Your doctor will also make sure you understand the potential benefits and risks of steroids before you start taking them.
You will have frequent blood tests while taking steroids to monitor possible side effects and to evaluate the effectiveness of therapy. These blood tests can usually detect problems before you are aware of any symptoms. Your doctor will also frequently evaluate your heart and lung function, and blood sugar level, which may be increased secondary to steroids.
While taking steroids, it is important to keep all appointments with your doctor and the laboratory and have your blood pressure checked regularly. Because steroids increase your chance of developing an infection, report symptoms such as a cough, fever, or shortness of breath to your doctor.
Because steroids can make bones weak, patients with GCA or PMR should have bone density testing performed to determine if they require supplemental calcium, vitamin D, and other medications to keep their bones at maximal strength and prevent loss of density.
Long-term steroid treatment (for a few months to several years) requires additional testing and monitoring. The potential side effects caused by long-term steroid therapy should be discussed with your doctor.
Once disease control is achieved, your doctor will slowly reduce prednisone to the lowest effective dose to control symptoms. In some patients there may not be any steroid requirement at all after 6 to 12 months of therapy.
Some studies have demonstrated that the risk of vascular complications is decreased among patients who also take one low dose aspirin a day. Patients who are unable to take aspirin include those with aspirin allergy or others who are receiving anticoagulation-related medications (blood thinners).