Polymyalgia Rheumatica (PMR) is a common inflammatory condition that primarily affects adults over 50, with an average age of onset around 70 years. It causes widespread aching and stiffness, particularly in the shoulders, neck, and hips.
Understanding Polymyalgia Rheumatica
Polymyalgia Rheumatica is characterized by inflammation, leading to stiffness and pain in multiple muscle groups. These symptoms are often worse in the morning or after periods of inactivity, making everyday tasks challenging. The condition is more prevalent in people of Northern European descent. While it is known to be an inflammatory disorder, the exact cause of PMR remains unknown. The symptoms of PMR can significantly impair a person’s quality of life, often manifesting as fatigue, low-grade fever, and unintentional weight loss in addition to the prominent pain and stiffness.
Established Treatment Approaches
The standard treatment for Polymyalgia Rheumatica has long been corticosteroids, such as prednisone. These medications are highly effective at reducing inflammation and alleviating pain, often providing rapid relief. A typical treatment course can last for several months to a few years, with the dosage gradually tapered down over time.
Despite their effectiveness, long-term use of corticosteroids presents several challenges and potential side effects. These can include bone density loss (osteoporosis), weight gain, increased risk of infections, and the development of diabetes. The need to manage these side effects, combined with the difficulty some patients have in tapering off corticosteroids without experiencing disease flares, has driven the search for alternative therapies.
Investigational and Recently Approved Therapies
Newer treatments are emerging, offering alternatives or additions to current PMR management. Sarilumab (Kevzara) stands out as the first and currently only biologic treatment approved by the US Food and Drug Administration (FDA) for Polymyalgia Rheumatica in adult patients who have had an inadequate response to corticosteroids or cannot tolerate corticosteroid taper.
Sarilumab is a monoclonal antibody that inhibits the interleukin-6 (IL-6) pathway, which is a key process in inflammation. The FDA’s approval of sarilumab for PMR was based on positive results from the Phase 3 SAPHYR clinical trial. This trial demonstrated that approximately 28% of sarilumab-treated patients achieved sustained remission compared to about 10% in the placebo group over 52 weeks.
Sarilumab is administered via subcutaneous injection. Its approval for PMR provides a new option for patients seeking relief from disabling symptoms and aiming to reduce their long-term dependence on corticosteroids. Other classes of drugs, such as Janus Kinase (JAK) inhibitors and other immunomodulators, are also being explored in clinical trials to offer additional corticosteroid-sparing effects and improve symptom management for PMR patients.
Considerations for Patients
For individuals living with Polymyalgia Rheumatica, discussing all available treatment options with a healthcare provider, particularly a rheumatologist, is important. These specialists can assess individual conditions, medical histories, and responses to previous therapies to determine the most suitable treatment plan. Treatment decisions are individualized, taking into account the potential benefits and risks of each medication.
It is strongly advised against self-medication, as proper diagnosis and ongoing medical supervision are necessary for managing PMR effectively. Research into PMR treatments is ongoing. Staying informed and maintaining open communication with healthcare professionals will ensure patients receive the most appropriate and up-to-date treatment.