The British Society for Rheumatology has published a new guideline for treating polymyalgia rheumatica, replacing its 2009 guidance. It was developed using GRADE and AGREE II methods.
Glucocorticoids remain the cornerstone. But many patients relapse during tapering and end up on steroids for years. The guideline therefore includes options for a faster glucocorticoid taper, consideration of early methotrexate, IL-6 receptor antagonists for people who cannot taper or have had an inadequate response, and bone protection for everyone with PMR. It also sets out when to discuss with or refer to rheumatology, and stresses education and monitoring for steroid toxicity.
For older patients, the cumulative steroid dose drives fractures, diabetes, cataracts, infection and muscle loss. A guideline that pushes earlier steroid-sparing treatment and universal bone protection changes day-to-day management.
In India, methotrexate is cheap and widely available; IL-6 receptor antagonists are costly. Bone protection with calcium, vitamin D and a bisphosphonate where appropriate is the step most clinicians can take today.
- Start bone protection in every patient with PMR on glucocorticoids
- Consider early methotrexate for patients at risk of prolonged steroid use
- Discuss a faster steroid taper where disease is controlled
- Refer or discuss with rheumatology when tapering repeatedly fails
- Monitor glucose, blood pressure, weight and bone health throughout treatment
Why it matters
It moves PMR care from steroids alone towards earlier steroid-sparing treatment and routine bone protection.
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