Questions and Answers about Polymyalgia Rheumatica and Giant Cell Arteritis
How Are They Treated?
The treatment of choice for both polymyalgia rheumatica and
giant cell arteritis is corticosteroid medication, usually prednisone.
Polymyalgia rheumatica responds to a low daily dose of
prednisone that is increased as needed until symptoms disappear. At this point,
the doctor may gradually reduce the dosage to determine the lowest amount
needed to alleviate symptoms. Most patients can discontinue medication after 6
months to 2 years. If symptoms recur, prednisone treatment is required
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin
and ibuprofen (Advil, Motrin*), also may be used to treat polymyalgia rheumatica.
The medication must be taken daily, and long-term use may cause stomach
irritation. For most patients, NSAIDs alone are not enough to relieve
Even without treatment, polymyalgia rheumatica usually
disappears in 1 to several years. With treatment, however, symptoms disappear
quickly, usually in 24 to 48 hours. If prednisone doesn’t bring improvement,
the doctor is likely to consider other possible diagnoses.
Giant cell arteritis is treated with high doses of prednisone.
If not treated promptly, the condition carries a small but definite risk of
blindness, so prednisone should be started as soon as possible, perhaps even
before confirming the diagnosis with a temporal artery biopsy.
As with polymyalgia rheumatica, the symptoms of giant cell
arteritis quickly disappear with treatment; however, high doses of prednisone
are typically maintained for 1 month.
Once symptoms disappear and the sed rate is normal, there is
much less risk of blindness. At that point, the doctor can begin to gradually
reduce the prednisone dose.
In both polymyalgia rheumatica and giant cell arteritis, an
increase in symptoms may develop when the prednisone dose is reduced to lower
levels. The physician may need to hold the lower dose for a longer period of
time or even modestly increase it again, temporarily, to control the symptoms.
Once the symptoms are in remission and the prednisone has been discontinued for
several months, recurrence is less common.
Whether taken on a long-term basis for polymyalgia rheumatica
or for a shorter period for giant cell arteritis, prednisone carries a risk of
side effects. While long-term use and/or higher doses carry the greatest risk,
people taking the drug at any dose or for any length of time should be aware of
the potential side effects, which include:
- fluid retention and weight gain
- rounding of the face
- delayed wound healing
- bruising easily
- myopathy (muscle wasting)
- increased blood pressure
- decreased calcium absorption in the bones, which can lead to
- irritation of the stomach
- increase in infections.
People taking corticosteroids may have some side effects or
none at all. Anyone who experiences side effects should report them to his or
her doctor. When the medication is stopped, the side effects disappear. Because
prednisone and other corticosteroid drugs reduce the body’s natural production
of corticosteroid hormones, which are necessary for the body to function
properly, it is important not to stop taking the medication unless instructed
by a doctor to do so. The patient and doctor must work together to gradually
reduce the medication.
* Brand names included in this booklet are
provided as examples only, and their inclusion does not mean that these
products are endorsed by the National Institutes of Health or any other
Government agency. Also, if a particular brand name is not mentioned, this does
not mean or imply that the product is unsatisfactory.