2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative

Abstract

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR

Incidence, prevalence and treatment burden of polymyalgia rheumatica in the UK over two decades: a population-based study

“…With regard to GC therapy, 75% received a first dose between 8 and 21 mg, which corresponds well to the recommended starting dose of 12.5–25 mg 2. The median duration of treatment of patients with GC in our sample is, however, less than that found by Shbeeb et al 29 in their recent study into GC prescribing in a cohort of 359 patients with PMR in Olmsted County, Minnesota.…”

“…Joint guidance released by the American College of Rheumatology and the European League Against Rheumatism advises GC treatment for most patients with PMR should end by 2 years 2. However, it has been suggested a large proportion of patients experience symptom flare on cessation, or even reduction, of GC therapy (a ‘symptom tail’) 11…”

Gut and Liver in Vasculitic Disorders

“…Table 3 shows an overview of current medication options in vasculitis including current recommendations [13,14,17,26,27,29,32,33]. Corticosteroids are still the drug of choice to induce remission.…”

“…However, in most of the cases, the diagnosis can be made prior to these deleterious situations and then immunosuppressive therapy should start immediately not only to avoid occlusion of a vessel but also to improve the overall situation of the patient, as all vasculitides are regarded systemic inflammatory diseases. Fortunately, a large number of studies for small to large vessel vasculitides is available for the treating physician, although most of the drugs still need to be applied in an off-label situation [15,17,26,27,28,29,30,31,32,33]. …”

How useful is PET/CT in the evaluation of fever/inflammation of unknown origin? Comment on the article by Schönau et al

“…Just pointing to a right diagnosis (true positive rate) does not necessarily mean helpfulness. For example, demonstrating abnormal uptake in shoulders is not in general necessary to begin treatment of polymyalgia rheumatica diagnosed on clinical and laboratory grounds 3. To justify the wide use of PET/CT, it is necessary to demonstrate when and how the exam was decisive for correct diagnosis and treatment.…”