Treatment

Glucocorticosteroid therapy, usually with prednisone, is the treatment of choice for PMR and GCA (3). Initially, 10 to 20 mg of prednisone per day is used to manage PMR and generally results in prompt resolution of symptoms within a few days of initiation. The usual disease course for PMR averages between two and one-half and three years, although, in rare instances, patients may require some amount of treatment for periods of more than five years.

GCA should be treated with prednisone, 40 to 60 mg daily, given as a single dose or in divided doses (3). This initial dose is usually administered for two to four weeks and then is gradually reduced by about 10% of the total daily dose on a weekly to biweekly basis. As with PMR, the disease course may be protracted; GCA has an average disease duration of about three years. In most patients, glucocorticosteroid doses generally can be tapered over this period of time.

Patients with impending or acute visual loss may be treated with pulse IV methylprednisolone, usually at doses of 1000 mg daily for three days (3). Patients who have suffered visual loss usually do not recover vision, although it has been suggested that coadministration of low-dose aspirin may reduce the rate or severity of visual loss (24).

During treatment, patients should have followup every two to four weeks, particularly in the initial phase of treatment of clinical symptoms, with measurement of acute-phase reactants including the ESR or C-reactive protein. A clinical dilemma occurs when patients are asymptomatic but have an isolated increased ESR in the absence of other symptoms. There are, to date, no reliable predictors for duration of glucocorticosteroid therapy. At present, there are no universally agreed upon or proven adjunctive or alternative therapies to glucocorticosteroids for the management of GCA or PMR (25).

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