Polymyalgia rheumatica may be hard to diagnose. Because rheumatologists are experts in diseases of the joints, muscles and bones, they can recognize the diagnosis of PMR and expertly manage its treatment.
In PMR, results of blood tests to detect inflammation are most often abnormally high. One such test is the erythrocyte sedimentation rate (ESR), also called “sed rate.” Another test is the C-reactive protein, or CRP. Both tests may be very elevated in PMR but, in some patients, these tests may have normal or only slightly high results. Your health care providers should rule out other similar health problems, such as rheumatoid arthritis.
If your doctor strongly suspects PMR, you will receive a trial of low-dose corticosteroids. Often, the dose is 10–15 milligrams per day of prednisone (Deltasone, Orasone, etc.). If PMR is present, the medicine quickly relieves stiffness. The response to corticosteroids can be dramatic. Sometimes patients are better after only one dose. Improvement can be slower, though. But, if symptoms do not go away after two or three weeks of treatment, the diagnosis of PMR is not likely, and your doctor will consider other causes of your illness.
Nonsteroidal anti-inflammatory drugs (commonly called NSAIDs), such as ibuprofen, (Advil, Motrin, etc.) and naproxen (Naprosyn, Aleve) are not effective in treating PMR.
When your symptoms are under control, your doctor will slowly decrease the dose of corticosteroid medicine. The goal is to find the lowest dose that keeps you comfortable. Some people can stop taking corticosteroids within a year. Others, though, will need a small amount of this medicine for 2–3 years, to keep aching and stiffness under control. Symptoms can recur and often do if medicine is decreased too quickly. Because the symptoms of PMR are sensitive to even small changes in the dose of corticosteroids, your doctor should direct the gradual decrease of this medicine.