In polymyalgia rheumatica, new flare-ups can occur despite treatment. When there is a risk and what to do then.
Those suffering from polymyalgia rheumatica have to deal with distressing symptoms that go far beyond ordinary “age-related aches”: Typical symptoms include pain in the shoulder, neck, and hip muscles, along with pronounced morning stiffness and a general feeling of illness.
The triggers of the symptoms are inflammation in the blood vessels that supply the muscles in the shoulder and hip regions. The exact cause of this inflammation is not fully understood. Nevertheless, the disease can usually be effectively treated with medication: Glucocorticoids, also known as corticosteroid medications, can typically bring the inflammation – and thus the symptoms – under control quickly and effectively.
However, it often takes years for those affected to be free of symptoms without medication. And for some, the inflammation flares up again despite treatment.
For a large majority of those affected, the pain and stiffness decrease within days to weeks during treatment. However, not infrequently – in about 40 out of 100 patients – relapses occur within a year of starting therapy, meaning their shoulder and hip muscles begin to hurt again.
Certain risk factors promote such relapses. Studies have shown that these are particularly common in patients who
- are female,
- have pronounced inflammation at the start of treatment (i.e., high inflammatory values), and/or
- have additional joint inflammation (peripheral arthritis).
In addition, new flare-ups can occur when the affected person
- has been prescribed a dosage of corticosteroids that is too low, or
- stops treatment prematurely.
The former can occur if the corticosteroid treatment is tapered off too quickly. The physician must gradually reduce the corticosteroid dosage during treatment. This is correct and necessary – also to reduce the risk of unwanted effects that increase with the duration of use. However, if the dosage is reduced too much too soon, inflammation may recur.
Regular check-ups are important to prevent this. During these visits, the physician checks the current inflammatory values and the overall health status of the affected person.
The findings provide information about whether the treatment is sufficiently effective and whether the dosage has been reduced at the right pace. If not, the dosage must be adjusted. Ideally, this allows for relapses to be prevented in a timely manner.
If a person with polymyalgia rheumatica notices inflammatory flare-ups despite corticosteroid treatment, they should inform their doctor. The doctor will try to adjust the treatment so that the inflammation – and thus the symptoms – diminish as quickly as possible.
This may require a higher dose of corticosteroids, which will then be slowly reduced again. On the other hand, the physician may consider prescribing another medication: Methotrexate.
This is originally a cancer medication. However, it has also been shown to help in various inflammatory autoimmune diseases, of which polymyalgia rheumatica is one.
Since the effectiveness of methotrexate for this disease is not as well established as that of corticosteroid therapy, it is only used in specific cases – namely, when
- the corticosteroid treatment is insufficient, causing relapses (i.e., flare-ups of the disease) to occur, and/or
- it is foreseeable that the side effects of corticosteroid therapy will significantly burden the health of the affected person.
Polymyalgia rheumatica is not life-threatening. However, if there are repeated flare-ups that require a lengthy treatment with corticosteroids, serious side effects can occur. Among other things, high blood pressure, osteoporosis, and diabetes mellitus can develop.
Whether and to what extent the risk for these diseases exists in an affected person depends on their individual health circumstances as well as the duration and dosage of corticosteroid therapy.
Only a medical professional can provide a well-founded assessment on this. They may also be able to suggest measures to reduce the risk of unwanted consequences of corticosteroid therapy. For example, exercise and a healthy diet can contribute to the prevention of diabetes mellitus.
Understanding Polymyalgia Rheumatica: Trends and Future Outlook
Polymyalgia rheumatica (PMR) poses significant challenges for those afflicted, often characterized by debilitating pain and stiffness in the shoulders, neck, and hips. Despite effective treatment options available through glucocorticoids (commonly known as corticosteroids), relapse can occur in a substantial number of patients within the year following therapy initiation. Recent studies indicate that approximately 40% of patients may experience flare-ups, underscoring the need for ongoing monitoring and tailored treatment strategies.
The inflammatory nature of PMR, linked to vascular issues affecting muscle supply, has prompted researchers to investigate the underlying mechanisms more deeply. Future therapeutic approaches may involve a more personalized management plan that leverages genetic profiling and patient history to predict treatment responses, thereby minimizing the likelihood of relapse.
One trend gaining traction is the integration of alternative medications such as methotrexate, traditionally used for cancer treatment but now recognized for its potential benefits in autoimmune disorders. While its effectiveness in PMR is not as established as corticosteroids, its application could expand, particularly for patients facing difficulties with corticosteroid tapering or experiencing significant side effects from prolonged use.
Additionally, the emphasis on lifestyle interventions as complementary measures is becoming increasingly prominent. Evidence suggests that regular exercise and nutritional modifications can help mitigate the risks associated with chronic corticosteroid use, including hypertension and osteoporosis. Future treatment protocols may place greater importance on patient education regarding diet and physical activity as integral components of holistic management.
As healthcare providers continue to refine their approaches to PMR, the focus will likely shift toward proactive measures. Regular monitoring of inflammation markers will aid in ensuring that treatment adjustments are made at the right time, potentially preventing further complications and improving patient quality of life. The evolving landscape of PMR care aims not only to alleviate symptoms but also to enhance overall well-being, emphasizing the importance of collaboration between patients and healthcare professionals.