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Treatments and drugs
By Mayo Clinic staffNonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) can be effective in treating mild symptoms of polymyalgia rheumatica. However, long-term use of NSAIDs can cause stomach and intestinal bleeding, fluid retention, high blood pressure, renal insufficiency, worsening congestive heart failure, liver function test abnormalities, and possible cognitive changes.
Corticosteroids
In most cases, the usual polymyalgia rheumatica treatment is a low, daily dose of an oral corticosteroid drug such as prednisone. Relief should be almost immediate. If you're not feeling better in a few days, it's likely you don't have polymyalgia rheumatica. In fact, your response to medication is one way your doctor may confirm the diagnosis.
After the first month, when your sed rate and platelet count have normalized, and any anemia is improved, your doctor will gradually start lowering the amount of cortisone you take until you reach the lowest possible dosage needed to control inflammation. Some of your symptoms may return during this tapering-off period. If so, tell your doctor so that your dosage can be adjusted appropriately.
The amount of time on medication varies from person to person. Most people are able to discontinue steroids within two years. Don't stop taking this medication on your own, however. Because corticosteroids suppress your body's natural production of cortisone, stopping suddenly can make you very ill.
At the same time, taking steroids, even in low doses, for long periods can lead to a number of side effects. This is especially true for older adults — those most likely to be treated for polymyalgia rheumatica. That's because they're more prone to develop certain conditions that also may be caused by corticosteroids, such as:
- Osteoporosis. This condition causes bones to become so weak and brittle that even slight movements such as bending over, lifting a vacuum cleaner or coughing can cause a fracture. Older women are most at risk of osteoporosis, and taking steroid medications increases the risk. For this reason, your doctor is likely to monitor your bone density and may prescribe calcium and vitamin D supplements or other medications to help prevent bone loss.
- High blood pressure (hypertension). Long-term corticosteroid use can also raise blood pressure. Your doctor is likely to monitor your blood pressure and may recommend an exercise program, diet changes and sometimes medication to keep blood pressure within a normal range.
- Cataracts. Cortisone increases your risk of cataracts, a condition that causes the lens of the eye to become cloudy, impairing vision.
Other possible side effects of cortisone therapy include weight gain, decreased immune system function — making you more prone to infections — muscle weakness and high blood sugar levels, which may increase your risk of diabetes or worsen diabetes you already have.
Because of these risks, researchers are investigating other medications to treat polymyalgia rheumatica. Researchers have reported some success with a combination of the drug methotrexate and corticosteroids, but more research is needed to recommend this approach. In some cases, you and your doctor may decide that the balance of risks and benefits lies in favor of using NSAIDs to control symptoms, rather than corticosteroids.
