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Polymyalgia Rheumatica (PMR) Treatment: Essential Guide

By Dr. Megan Milne, PharmD, BCACP
Polymyalgia Rheumatica (PMR) Treatment: Essential Guide

When it comes to treating polymyalgia rheumatica, understanding your options is half the battle. Muscle aches and stiffness don’t have to take over your life, even though they’re symptoms of this well-known condition. Effective management starts here—with insights into what works best from medication to lifestyle adjustments.

Why does this matter? Because getting a grip on polymyalgia rheumatica means reclaiming your mornings from pain and stiffness. Let’s explore how treatments like corticosteroids transform lives by offering quick relief and what other supports are out there. Find out exactly how to find relief from prednisone side effects.

Table Of Contents:

What is Polymyalgia Rheumatica (PMR)?

Polymyalgia rheumatica (PMR) is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips. It’s a condition that can develop quickly, with symptoms appearing over a few days to weeks. Polymyalgia rheumatica is closely related to another inflammatory condition called giant cell arteritis, which causes inflammation of the blood vessels.

So what exactly causes polymyalgia rheumatica? The exact cause is still unknown, but it’s believed to involve a combination of genetic and environmental factors. Some research suggests that certain genes may make people more susceptible to developing the condition.

Symptoms and Causes of PMR

The most common symptoms of polymyalgia rheumatica are muscle pain and stiffness, particularly in the shoulders, neck, upper arms, and hips. The stiffness is usually worse in the morning and can make it difficult to get out of bed or move around. 

Other symptoms may include:

  • Fatigue
  • Low-grade fever
  • Loss of appetite
  • Unintended weight loss
  • Depression

These symptoms can come on suddenly and may be severe enough to affect daily activities. The shoulder pain can be debilitating and make it impossible to do simple activities like lift a cup to drink, latch a bra, put food in your mouth, or get dressed. In some cases, people with polymyalgia rheumatica may also develop giant cell arteritis (GCA), which can cause headaches, vision changes, and jaw pain. Both conditions are believed to have an autoimmune component, with the body’s immune system mistakenly attacking healthy tissues. While they are separate conditions, individuals with PMR are at higher risk of developing GCA, and vice versa.

Polymyalgia Rheumatica Diagnosis and Tests

Diagnosing polymyalgia rheumatica can be challenging because the symptoms are similar to those of other conditions, such as rheumatoid arthritis and fibromyalgia. There’s no single test that can definitively diagnose polymyalgia rheumatica, so doctors often rely on a combination of factors, including:

  • Medical history and physical exam
  • Blood tests to check for inflammation and rule out other conditions
  • Imaging tests, such as ultrasound or MRI, to look for inflammation in the joints and soft tissues

One of the key features of polymyalgia rheumatica is a rapid response to treatment with corticosteroids. If symptoms improve significantly within a few days of starting steroid treatment, it can help confirm the diagnosis.

The Seven Hallmark Characteristics of PMR Include:

  1. Age 50 or older
  2. Symptoms lasting 2 weeks or more
  3. Aching of both shoulders and/or pelvic girdle. It must be “bilateral.”
  4. Morning stiffness lasting at least 45 minutes
  5. Elevated ESR (erythrocyte sedimentation rate) (normal is usually less than 20-30 mm/hr)
  6. Elevated CRP (C-reactive protein) level in the blood (normal is usually less than 1 mg/dL)
  7. Rapid response to corticosteroids like prednisone

While the exact cause of polymyalgia rheumatica remains a mystery, ongoing research is helping to shed light on this complex condition. Since it seems to be related to body’s own immune system attacking healthy tissues, PMR is likely an autoimmune disease. By better understanding the underlying mechanisms and risk factors, we may be able to develop more targeted treatments and prevention strategies in the future.

Treatment Options for Polymyalgia Rheumatica

If you’ve been diagnosed with polymyalgia rheumatica, you’re probably wondering what your treatment options are. The good news is that with proper treatment, most people with polymyalgia rheumatica can find relief from their symptoms and get back to their normal activities. Here’s what you need to know about the different treatment options available.

Corticosteroids like Prednisone for PMR

The mainstay of treatment for polymyalgia rheumatica is corticosteroid medication, usually in the form of oral prednisone. Prednisone works by reducing inflammation in the body, which helps to relieve pain and stiffness. Most people with polymyalgia rheumatica will start on a medium-high dose of prednisone, usually around 12.5 to 25 mg prednisone mg per day.

After a few weeks, the dose is gradually tapered down as symptoms improve. The goal is to find the lowest effective dose that keeps symptoms under control. Some people may need to stay on a low maintenance dose of prednisone for several months or even years to prevent relapses.

“Since being diagnosed with PMR and starting Prednisone, I’ve found peace of mind with Nutranize. It’s comforting to know my body is supported through these side effect challenges.”

Denise

Interleukin-6 Inhibitors: Alternatives to Prednisone for PMR

For people who don’t respond well to corticosteroids or who have trouble tapering off the medication, a newer class of drugs called interleukin-6 (IL-6) inhibitors may be an option. These drugs, such as tocilizumab (Actemra) and sarilumab (Kevzara), work by blocking the action of IL-6, a protein that plays a key role in inflammation.

Studies have shown that IL-6 inhibitors can be effective in reducing symptoms and allowing people to taper off corticosteroids more quickly. However, these drugs can have side effects, including an increased risk of infections, so they’re not right for everyone.

Other Medications for PMR

In some cases, other medications may be used in addition to or instead of corticosteroids to help manage polymyalgia rheumatica symptoms. These may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen*
  • Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate
  • Biologic agents, such as abatacept or rituximab

The choice of medication will depend on several factors, including the severity of symptoms, the presence of other health conditions, and individual preferences. There is not much evidence for these medications as not many scientific trials have shown benefit. *The PMR guidelines strongly recommend not using NSAIDs since they are more likely to cause harm and have very little benefit in PMR.

Non-Pharmacologic Treatments for PMR Disease

In addition to medication, there are several non-pharmacologic treatments that can help manage polymyalgia rheumatica symptoms and improve overall well-being. These may include:

  • Physical therapy to improve strength and flexibility
  • Occupational therapy to help with daily activities
  • Exercise, such as walking or swimming, to maintain muscle strength and reduce stiffness
  • Heat therapy, such as warm compresses or hot baths, to relieve pain and stiffness
  • Stress management techniques, such as meditation or deep breathing, to reduce anxiety and promote relaxation

The key is to work with your healthcare team to develop a comprehensive treatment plan that addresses your individual needs and goals. With the right combination of medication and lifestyle changes, most people with polymyalgia rheumatica can successfully manage their symptoms and maintain a good quality of life.

Managing Side Effects of Polymyalgia Rheumatica Treatment

While corticosteroids like prednisone are very effective at reducing inflammation and relieving symptoms of polymyalgia rheumatica, they can also cause a range of side effects, especially when used long-term. It’s important to be aware of these potential side effects and work with your doctor to manage them.

Common Side Effects of Prednisone

Some of the most common side effects of prednisone treatment include:

Not everyone will experience all of these side effects, and the severity can vary from person to person. Some side effects, like weight gain and mood changes, may be more noticeable and bothersome than others.

prednisone side effect cartoon

Serious Side Effects of Prednisone

In rare cases, corticosteroid treatment of PMR with prednisone can also cause more serious side effects, such as:

These serious side effects are more likely to occur with high doses or long-term use of corticosteroids. Your doctor will monitor you closely for any signs of these complications and may adjust your treatment plan if necessary.

It’s also important to be aware of the signs of adrenal insufficiency, which can occur if you suddenly stop taking corticosteroids or reduce your dose too quickly. Symptoms of prednisone withdrawal may include fatigue, weakness, nausea, and low blood pressure. If you experience these symptoms, contact your doctor right away.

Strategies for Coping with Side Effects

There are several strategies you can use to help manage the side effects of corticosteroid treatment:

  • Follow a healthy diet and exercise regularly to help control weight gain and maintain bone health
  • Take calcium and vitamin D supplements to help prevent osteoporosis
  • Practice stress management techniques, such as deep breathing or meditation, to help with mood changes and sleep problems
  • Have regular eye exams to check for cataracts and glaucoma
  • Quit smoking and drinking alcohol to help prevent osteoporosis
  • Talk to your doctor about adjusting your dose or switching to a different medication if side effects become severe or unmanageable

Nutranize Zone for Prednisone Side Effect Relief

Nutranize Zone is a dietary supplement designed specifically for people on prednisone. It contains ingredients known to support bone health, blood sugar levels, restful sleep, enhanced mood, and overall well-being. For individuals with PMR (polymyalgia rheumatica) who are taking prednisone, Nutranize can help mitigate some of the common side effects associated with long-term steroid use. By incorporating Nutranize into your daily routine, you may experience improved outcomes during your prednisone tapering process and beyond.

“Thanks to Nutranize, I successfully tapered off prednisone after 18 months without major side effects. My weight gain is decreasing, bone density remained stable, and my sugar levels improved. I credit these positive outcomes to Nutranize. If my PMR symptoms return, I will definitely reactivate my subscription. Thank you, Dr. Megan!”

Rick
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Monitoring and Follow-Up Care

Everyone responds differently to corticosteroid treatment, and what works for one person may not work for another. Work closely with your doctor to find the right balance of medication and lifestyle changes to manage your polymyalgia rheumatica symptoms while minimizing side effects.

Here’s what you can expect from your follow-up care.

Assessing Treatment Response

One of the main goals of follow-up care is to assess how well you’re responding to treatment. Your doctor will ask about your symptoms, including pain, stiffness, and fatigue, and how they’ve changed since starting treatment. They may also perform a physical exam to check for any signs of inflammation or joint damage.

In addition to your symptoms, your doctor may order blood tests to check for markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These inflammatory marker tests can help determine if your treatment is effectively reducing inflammation in your body.

Good news is I am rather suddenly about 4 days ago feeling better!! This was about 8 days after starting your Nutranize supplements. You said it can take longer depending on dosage, duration and disease. At least the first two apply to me and perhaps suspected GCA as well. I woke this morning going “Oh my gosh: This is the real me back!”

Christine, GCA Warrior

Adjusting Medication Dosage

Based on your treatment response and any side effects you may be experiencing, your doctor may adjust your medication dosage. This is especially common with corticosteroids like prednisone, which are usually started at a high dose and then gradually tapered down over time.

If your symptoms are well-controlled, your doctor may recommend reducing your prednisone dose by a small amount every few weeks or months. If your symptoms worsen or you experience a flare-up, your doctor may need to increase your dose temporarily to get the inflammation back under control.

Tapering Off Prednisone

The ultimate goal of treatment for polymyalgia rheumatica is to gradually taper off corticosteroids and achieve remission. However, this process can take several months or even years, and some people may need to stay on a low maintenance dose of prednisone indefinitely to prevent relapses.

Your doctor will work with you to develop a tapering plan that balances the need for symptom control with the risks of long-term corticosteroid use. It’s important to follow your tapering plan closely and not stop taking your medication suddenly, as this can cause withdrawal symptoms and increase your risk of a flare-up.

The PMR Treatment Guidelines recommend this for tapering prednisone:

  1. Initial tapering: Taper dose to an oral dose of 10 mg/day prednisone equivalent within 4–8 weeks.

  2. Relapse therapy: Increase oral prednisone to the pre-relapse dose and decrease it gradually (within 4–8 weeks) to the dose at which the relapse occurred.

  3. Tapering once remission is achieved (following initial and relapse therapies): Taper daily oral prednisone by 1 mg every 4 weeks (or by 1.25 mg decrements using schedules such as 10/7.5 mg alternate days, etc.) until discontinuation given that remission is maintained.

Many people with PMR regret tapering too fast, and usually need to taper much slower than people taking prednisone for other conditions. These are my best tapering tips and resources, including a free printable taper chart.

Watching for Relapse

Even after achieving remission and tapering off corticosteroids, there’s always a risk of relapse with polymyalgia rheumatica. In fact, studies have shown that up to 50% of people with polymyalgia rheumatica will experience at least one relapse within the first two years of diagnosis.

To help catch relapses early, it’s important to stay vigilant for any signs of returning symptoms, such as increased pain, stiffness, or fatigue. If you notice any of these symptoms, contact your doctor right away so they can adjust your treatment plan and prevent the inflammation from getting worse.

What’s tricky is that the signs of prednisone withdrawal may overlap the signs of a PMR relapse. It’s hard to tell the difference. Generally, in both cases you go back up to the last effective dose of prednisone, (see #2 above).

In addition to regular follow-up appointments, your doctor may also recommend bone density scans and other tests to monitor for potential complications of long-term corticosteroid use, such as osteoporosis or cataracts.

Remember, everyone’s experience with polymyalgia rheumatica is different, and there’s no one-size-fits-all approach to treatment and follow-up care. Work closely with your doctor to develop a plan that meets your individual needs and helps you achieve the best possible outcome.

Living with Polymyalgia Rheumatica

Living with polymyalgia rheumatica can be challenging, but there are many strategies you can use to manage your symptoms and maintain your quality of life. Here are some tips for coping with polymyalgia rheumatica on a daily basis. 

Check out this interview with Diane Wells, a Prednisone Warrior who found ways to thrive while taking prednisone for PMR.

Coping Strategies

One of the most important things you can do to cope with polymyalgia rheumatica is to stay positive and proactive about your health. This means working closely with your healthcare team, following your treatment plan, and taking steps to manage your symptoms and prevent complications.

Some other coping strategies that may be helpful include:

  • Taking Nutranize Zone for side effect relief
  • Pacing yourself and taking breaks when needed
  • Using assistive devices, such as canes or grab bars, to make daily activities easier
  • Modifying your home or workplace to reduce strain on your joints
  • Seeking support from family, friends, or a support group
  • Finding ways to manage stress, such as through relaxation techniques or hobbies

Exercise and Physical Therapy

Exercise is an important part of managing polymyalgia rheumatica, as it can help reduce stiffness, maintain muscle strength, and improve overall function. However, it’s important to choose low-impact activities that don’t put too much strain on your joints, such as:

  • Walking
  • Swimming or water aerobics
  • Cycling

Key Takeaway: Polymyalgia rheumatica, with its swift-onset muscle pain and stiffness, especially in shoulders and hips, can be managed effectively. Starting on high-dose corticosteroids like prednisone offers quick relief. For those not responding well or struggling to taper off steroids, IL-6 inhibitors present a newer alternative. Alongside medication, lifestyle adjustments including physical therapy and stress management play a crucial role in enhancing quality of life.

FAQs in Relation to Polymyalgia Rheumatica Treatment

How serious is polymyalgia rheumatica?

It’s not life-threatening but can seriously cramp your style. Think pain, stiffness, and major discomfort without treatment.

What causes PMR flare ups?

Triggers include stress, infections, and sometimes medication changes. It’s like walking a tightrope with your immune system.

How debilitating is polymyalgia rheumatica?

Pretty rough. It can turn simple tasks into Herculean efforts. Morning routines? More like morning battles.

What is the life expectancy of someone with polymyalgia?

No direct hit on lifespan, but let’s manage symptoms to keep living full throttle.

What can I do to minimize the side effects of long-term prednisone?

Try taking Nutranize Zone along with prednisone to reduce your suffering by replenishing the nutrients prednisone steals so that you can recover from taking prednisone. Plus, it comes with a 100% money-back guarantee, so you have nothing to lose by trying it.

Conclusion

The journey through finding the right polymyalgia rheumatica treatment might seem long but remember—every step forward is a move towards better health. We’ve walked through the essentials of managing this condition, from leveraging powerful medications like prednisone to embracing supportive therapies that ease symptoms.

This isn’t just about dodging discomfort; it’s about seizing back control over your well-being. With each strategy tailored specifically for those battling with polymyalgia rheumatica, freedom from morning stiffness and muscle pain isn’t just possible—it’s within reach.

Prednisone Warrior Craig’s PMR Story

“Blah… Blah… Blah” is all I have heard from overpriced supplement companies over the last 40 years. I’ve tried many with no appreciable effects… until now. I was recently diagnosed with PMR so I was put on Prednisone. I went from a relatively normal, sane, and lucid person into someone who by the end of the day felt horribly bad for being unreasonable, critical, and combative toward everyone around me. I would start each day telling myself that “today I will not behave like a paranoid jerk (jerk really stings, but my wife says this was the most accurate description for how prednisone has turned me into)”. Out of absolute desperation (with little hope), I learned of Dr. Megan and Nutranize Zone and went ahead and ordered some. Within 24 hours the craziness that would come out of the ether each day stopped showing its ugly face. Now for over a week, I have returned to the wonderful, cuddly, lovable (well maybe that’s a little much) man I have been for many years. Seriously… this has ABSOLUTELY improved my quality of life from dystopian embarrassment and shame to stability and normality! Thank you Dr. Megan!

Craig Helgerson
Nutranize Zone
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References:
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  4. Camellino D, Giusti A, Girasole G, Bianchi G, Dejaco C. Pathogenesis, Diagnosis and Management of Polymyalgia Rheumatica. Drugs Aging. 2019 Nov;36(11):1015-1026. doi: 10.1007/s40266-019-00705-5. PMID: 31493201.
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  7. Riccardo Pofi, Giorgio Caratti, David W Ray, Jeremy W Tomlinson, Treating the Side Effects of Exogenous Glucocorticoids; Can We Separate the Good From the Bad?, Endocrine Reviews, Volume 44, Issue 6, December 2023, Pages 975–1011. [Link]
  8. Harris E, Tiganescu A, Tubeuf S, Mackie SL. The prediction and monitoring of toxicity associated with long-term systemic glucocorticoid therapy. Curr Rheumatol Rep. 2015 Jun;17(6):513. doi: 10.1007/s11926-015-0513-4. PMID: 25903665.
  9. Esteves GP, Mazzolani BC, Smaira FI, Mendes ES, de Oliveira GG, Roschel H, Gualano B, Pereira RMR, Dolan E. Nutritional recommendations for patients undergoing prolonged glucocorticoid therapy. Rheumatol Adv Pract. 2022 Apr 21;6(2):rkac029. doi: 10.1093/rap/rkac029. PMID: 35539442; PMCID: PMC9080102.
  10. Humphrey MB, Russell L, Danila MI, et al. 2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Rheumatol. 2023 Dec;75(12):2088-2102. doi: 10.1002/art.42646. PMID: 37845798.

Prednisone Warrior Christine’s PMR Story

In the midst of our highly dysfunctional medical system, I was very relieved to discover The Prednisone Pharmacist online and am spreading the word about her where I can. I read and listened to almost all of Dr. Megan’s vast, free, and personable information and expertise on this poison-miracle drug.

After careful consideration and relevant consultations, I ordered her Nutranize supplements on a 3 month trial. I will continue them until I’m off prednisone. Initially, I was disappointed at reading a testimonial that described huge improvement after only a day on the supplements. At that time I was several days in but no apparent effect. However after a full week I awoke one morning stunned to realize that I felt like my old self; clear headed, eager to get up and get active. Depression, extreme fatigue and energy all distinctly improved until soon after the next taper began. Once adjusted to the new lower dose, I felt relatively much better again.

Thank you, Megan, for this boost in well being and hope. I am also most grateful for your personal and helpful responses to my general queries.

Christine Anderson
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Dr. Megan Milne, PharmD, BCACP

Dr. Megan Milne, PharmD, BCACP, is an award-winning clinical pharmacist board certified in the types of conditions people take prednisone for. Dr. Megan had to take prednisone herself for an autoimmune condition so understands what it feels like to suffer prednisone side effects and made it her mission to counteract them as the Prednisone Pharmacist.

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