Further Outpatient Care

Joint guidelines from the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) recommend regular monitoring that includes clinical assessment and laboratory studies, on the following schedule^[28]:

Every 4-8 weeks in the first year of treatment
Every 8-12 weeks in the second year
As indicated, in case of relapse or as prednisone is tapered off

Complications

PMR usually has a limited course of several months to 5 years. Untreated patients often feel unwell and have an impaired quality of life, but generally, PMR is not associated with serious complications. Patients treated with corticosteroids are at risk for long-term complications of corticosteroid therapy.

Relapses are common and may occur in up to 25% of all treated patients. Arteritic relapse in a patient who presented exclusively with PMR is unusual.

Every patient with PMR should be considered at risk for giant cell arteritis (GCA).

Several cases of systemic amyloidosis–associated PMR have been reported. Rare cases of bilateral ocular inflammation (episcleritis, scleritis, or anterior uveitis) developing during steroid tapering have been reported.^[58]

Prognosis

PMR is usually self-limited. With prompt diagnosis and adequate therapy, the condition has an excellent prognosis.

Patient Education

Inform the patient about the potential benefits and risks of corticosteroids treatment and encourage the patient to participate in choosing the treatment plan.

Emphasize the importance of healthy dietary habits and ensure adequate calcium and vitamin D supplementation.

Emphasize compliance with long-term treatment plans and follow-up care in order to prevent relapses, flares, and subsequent morbidity secondary to corticosteroid therapy.

Advise patients to immediately seek medical care if symptoms recur.

Questions

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Author

Ehab R Saad, MD, MA, FACP, FASN Associate Professor, Department of Medicine, Medical College of Wisconsin

Ehab R Saad, MD, MA, FACP, FASN is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, American Society of Transplantation, International Society for Peritoneal Dialysis, National Kidney Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Patricia J Papadopoulos, MD Staff Rheumatologist, MultiCare Rheumatology Specialists

Patricia J Papadopoulos, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American College of Rheumatology

Disclosure: Own small amount of stock for: Amazon, Johnson & Johnson, Proctor & Gamble, Cigna Corp, Pfizer.

Gloria Fioravanti, DO Clinical Assistant Professor, Program Director, Department of Internal Medicine, St Luke's Hospital of Bethlehem, Temple University School of Medicine

Gloria Fioravanti, DO is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

Allen J Samuels, MD Rheumatologist, Penn Highlands Rheumatology

Allen J Samuels, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American College of Rheumatology, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the US Government. Additionally, this publication does not imply the Federal or Department of Defense endorsement of any product.

Past Contributors

Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine