Polymyalgia Rheumatica (PMR) is a common inflammatory disorder that primarily affects adults over the age of 50. This condition causes significant pain and stiffness, predominantly in the muscles of the shoulders and hips. Morning stiffness lasting longer than 45 minutes is often a distinguishing feature. PMR is highly treatable and is generally considered a self-limiting disease, meaning it does resolve over time. Management requires a specific, long-term treatment plan focused on reducing inflammation until the disease process naturally concludes.
The Typical Duration and Remission
Polymyalgia Rheumatica eventually resolves, but the process is measured in years rather than weeks or months. Achieving full and sustained remission—being symptom-free and completely off medication—typically takes between one and two years. However, the duration varies widely, and some patients require continuous, low-dose treatment for four years or longer.
The total length of the disease course is influenced by individual factors, including the age of onset and the speed of the initial response to treatment. Although inflammation can be suppressed with medication, the underlying disease must run its course before treatment can be safely stopped. Remission is confirmed when inflammatory markers in the blood, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), have normalized without the return of stiffness and pain.
Standard Corticosteroid Treatment Protocol
The management of PMR relies on the use of low-dose oral corticosteroids, such as prednisone or prednisolone, to suppress systemic inflammation. This treatment rapidly controls the inflammation that causes pain and stiffness. A typical starting dose of prednisone is often 15 milligrams per day, though the range is usually between 12.5 and 25 milligrams, depending on the patient’s symptoms and health profile.
The response to this initial dose is often rapid, serving as a supporting factor for the diagnosis itself. Patients frequently report noticeable improvement in symptoms within 24 to 72 hours of starting treatment. This prompt relief is a hallmark of PMR. The medication is maintained at this initial effective dose until symptoms are well-controlled and inflammatory markers have returned to normal levels.
Managing Medication Reduction and Relapse
Once symptoms are fully controlled, the focus shifts to the gradual reduction of the corticosteroid dose, a process known as tapering. Tapering is a slow, methodical process personalized for each patient, often involving dose decreases as small as 1 milligram every four to eight weeks. The goal is to find the minimum effective dose needed to maintain symptom control while minimizing the long-term side effects associated with corticosteroids.
This prolonged tapering phase is necessary because reducing the medication too quickly can cause a disease flare or relapse. A relapse is the return of PMR symptoms, often accompanied by a rise in inflammatory blood markers. Relapses are common, occurring in up to 50% of patients, particularly when the dose is reduced below 7.5 milligrams per day or shortly after the medication is stopped.
If a relapse occurs, the dosage must be temporarily increased back to the last dose that effectively controlled the symptoms. The physician holds this higher dose until symptoms are stable before attempting a slower reduction. Successful resolution of PMR involves slowly withdrawing the medication while confirming the disease has become quiescent.
Monitoring for Related Conditions
Individuals diagnosed with PMR must remain vigilant for the development of an associated condition called Giant Cell Arteritis (GCA), also known as temporal arteritis. PMR and GCA are closely linked and are considered different manifestations of the same underlying disease process. GCA is a serious vasculitis that causes inflammation of medium- and large-sized arteries, and it can occur before, during, or even after a PMR diagnosis.
Patients should immediately report any new symptoms such as a persistent headache, pain in the jaw when chewing (jaw claudication), or scalp tenderness. Changes in vision, including temporary vision loss, double vision, or blurred vision, require immediate medical attention, as untreated GCA can lead to irreversible blindness.