Polymyalgia Rheumatica Medication

Updated: Jul 21, 2022
  • Author: Ehab R Saad, MD, MA, FACP, FASN; Chief Editor: Herbert S Diamond, MD  more...
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Medication Summary

The goals of therapy in polymyalgia rheumatica (PMR) are to control painful myalgia, to improve muscle stiffness, and to resolve constitutional features of the disease. Oral corticosteroids are the first line of treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful as adjuncts to corticosteroids during tapering, or alone in mild cases; however, because they are associated with increased drug-related morbidity, they should be used with caution, especially in elderly patients. Steroid-sparing agents may be beneficial.

The interleukin-6 receptor antagonist tocilizumab is approved for use in giant cell arteritis and has demonstrated benefit for PMR in several case series and retrospective studies. [57] However, controlled trials are needed to fully establish the efficacy of tocilizumab in PMR, and it has not yet been approved for this indication by the US Food and Drug Administration.




Class Summary

These agents cause profound and varied metabolic effects. Their exact mechanism of action in PMR is not well known, but their efficacy may stem from their general anti-inflammatory and immunomodulatory effects. In addition, corticosteroids down-regulate cytokine production.

Prednisone (Deltasone, Rayos)

Prednisone has the capacity to dramatically reduce inflammatory manifestations. Polymyalgia rheumatica is rapidly responsive to low doses of prednisone. However, patients may require treatment for several months to several years.

Prednisolone (Orapred ODT, Veripred 20, Millipred, Millipred DP)

Corticosteroids act as potent inhibitors of inflammation. They may cause profound and varied metabolic effects, particularly in relation to salt, water, and glucose tolerance, in addition to their modification of the immune response of the body. Alternative corticosteroids may be used in equivalent dosage.


Nonsteroidal Anti-Inflammatory Drugs

Class Summary

These agents can be administered to some patients with mild symptoms; however, patients require corticosteroids for total control of symptoms. NSAIDs may be helpful in later stages of corticosteroid dosage tapering, with close monitoring for drug-related morbidity. NSAIDs generally have no effect on the ESR.

Ibuprofen (I-Prin, Motrin, Caldolor, NeoProfen, Advil, Provil)

Ibuprofen is the drug of choice for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Anaprox DS, Aleve, Naprosyn, Naprelan)

Naproxen is indicated for relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.


Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient’s response.

Indomethacin (Indocin, Tivorbex)

Indomethacin is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.

Diclofenac (Cambia, Zipsor, Zorvolex, Dyloject)

Diclofenac inhibits prostaglandin synthesis by decreasing COX activity, which, in turn, decreases formation of prostaglandin precursors.


Antineoplastics, Antimetabolite

Methotrexate (Trexall, Xatmeb, Otrexup, Rasuvo, Rheumatrex)

Antineoplastic agent that is immunosuppressive at lower doses. Antirheumatic effects may take several weeks to become apparent. Unknown mechanism of action in treatment of inflammatory disorders; may affect immune function. Ameliorates symptoms of inflammation (eg, pain, swelling, stiffness).