New PMR guideline: faster steroid tapers, earlier methotrexate, bone protection for all

The edition in brief

The British Society for Rheumatology has replaced its 2009 polymyalgia rheumatica guidance. Glucocorticoids remain the cornerstone, but the guideline adds options for a faster taper, consideration of early methotrexate, IL-6 receptor antagonists for people who cannot taper or respond inadequately, bone protection for everyone with PMR, and clearer advice on when to refer. For older adults, whose steroid toxicity shows up as fractures, diabetes and infection, this is the main practical shift. NHANES data from 1999 to 2020 showed the average number of prescription drugs rose in every frailty group, reaching 7.8 among the moderately to severely frail, with metabolic and psychotropic drugs driving the increase. A US randomised trial of a low-intensity resource referral service for dementia caregivers did not improve self-efficacy at 12 months, but among those with social risks emergency visits fell (IRR 0.41). A Hong Kong trial of four motivational interviewing sessions for 198 older adults at risk of elder abuse found reductions in psychological aggression and caregiver neglect. The pearl covers lying and standing blood pressure in falls.