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While I understand your reluctance to take steroids long-term, the alternatives really aren’t satisfactory. Ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) commonly used to relieve pain and swelling are ineffective here, and physiotherapy is of no value initially — the pain and stiffness are too severe.
Other immunosuppressants, such as methotrexate and tocilizumab, are more toxic, less well researched for PMR, and are not recommended as stand-alone treatments at the present time.
Tapering the steroid dose helps ensure you are kept on the lowest possible dose to suppress your symptoms and reduce the long-term risk of side-effects.
Your practice nurse will see you regularly to monitor you and carry out blood tests, to adjust your prescription as necessary. (Patients are often advised to take daily calcium and vitamin D tablets to help protect against osteoporosis.)
The good news is that PMR usually responds rapidly to treatment, with patients experiencing a substantial improvement in their symptoms within days. What’s more, the condition often burns itself out within one or two years, after which the steroids can be stopped — although relapses can occur.
A note of caution for all patients with PMR: an intensely painful headache, scalp and jaw pain and sight problems can be signs of a more serious form of the condition, called giant cell arteritis (GCA), which can damage sight if not treated immediately with higher doses of the steroid.
So seek medical help urgently if you experience unexplained symptoms such as these.
Write to Dr Scurr
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — include your contact details.
Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.
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