Management of polymyalgia rheumatica in older people

Abstract

Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease affecting older people. For decades it has remained under-researched and poorly understood, despite causing significant disability. Once thought to be a self-limiting condition universally responsive to a limited course of prednisolone, it is now clear that most people with PMR require prolonged corticosteroids beyond two years. The cumulative burden of adverse effects from such therapy is thought to substantively contribute to reduced functionality and frailty in older patients, yet few effective alternative pharmacotherapies have been established. This review explores the latest developments regarding the effects of conventional corticosteroid treatment in PMR and the emerging potential of steroid-sparing agents.