The British Society for Rheumatology has replaced its 2009 polymyalgia rheumatica guideline, using GRADE and AGREE II methods. Polymyalgia is common in older adults, and many patients relapse as steroids are tapered, so years of glucocorticoid exposure and its harms are the usual price of treatment.
The update covers when to discuss or refer to rheumatology, how to start and taper glucocorticoids including the option of a faster taper, considering methotrexate early, using an IL-6 receptor antagonist for people who cannot taper or respond poorly, and bone protection for everyone with the condition. It also stresses patient education and monitoring for steroid toxicity.
For the generalist who diagnoses and manages most polymyalgia, the shift is towards planning for steroid-sparing therapy from the start rather than after the third relapse. Check the full guideline for doses and thresholds before changing a regimen.
- Start bone protection when you start glucocorticoids for polymyalgia
- Monitor glucose, blood pressure, weight and mood throughout steroid treatment
- Consider methotrexate early in patients at high risk of relapse or steroid harm
- Refer to rheumatology when tapering repeatedly fails or the diagnosis is uncertain
- Look for features of giant cell arteritis at every visit: new headache, jaw pain or visual symptoms
Why it matters
It moves methotrexate and biologics earlier in a condition where most of the harm comes from the treatment.
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