In the first place, treatment for polymyalgia rheumatica consists of small amounts of prednisone, such as 10 to 15 mg per day, which usually leads to a dramatic response. Moreover, this treatment is usually tapered to the minimum amount needed and then maintained for 1 1/2 to 2 years. In fact, some patients have to stay on corticosteroids for longer. To emphasize, with temporal arteritis the starting dose is much higher, usually 60 mg per day. To clarify, the physician reduces this dose carefully to the point where the inflammatory process in the cranial arteries is suppressed. Specifically, the focus is on preventing blindness. In general, treatment often has to be continued for 3 or 4 years.
Rheumatologists use azathioprine or methotrexate
Certainly, some rheumatologists use azathioprine or methotrexate as well to reduce the amount of corticosteroid. However, in this case the physician must monitor such side effects like bone marrow suppression or liver damage with other blood tests.
Side effects of osteonecrosis and osteoporosis from longterm corticosteroid use
It is important that the physician watches for side effects of osteonecrosis and osteoporosis. Particularly, both conditions occur more frequently with longterm corticosteroid use. Notably, the hip joint (head of the trochanter) is particularly sensitive for osteonecrosis. Some patients may require hip replacement surgery.
However, without treatment there is a high probability of blindness. The physician may find it difficult at times to strike the right balance whether to treat or not. This is particularly true considering the world of litigation that we are living in. The physician should put women in menopause on disodium etidronate (brand name: Didrocal), which increases the bone mineral density by 4% in one year and 4.8% in 2 years (Ref. 1, p. 59).
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 14.
2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 50.
3. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
4. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
5. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
6. B. Sears: “The age-free zone”.Regan Books, Harper Collins, 2000.
7. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
8. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008