Polymyalgia rheumatica

- inflammatory soft tissue condition characterised by persistent pain and stiffness of neck, shoulder girdle and pelvic girdle
- female aged more than 50 years
- proximal muscle pain (shoulder or pelvic) without weakness + early morning stiffness
- Lab findings: raised ESR(more than 40), raised CRP, abnormal LFT (ALP,GGT), anemia
- Response to corticosteroid is dramatic and prompt (within 24-72 hours). Optimal starting dose is 15mg od for first month.
- The risk of relapse is higher with smaller dose and risk of adverse event increased with larger dose.
- Initial dose reduction should be 2.5mg fortnightly until 10mg daily and reduce 1mg each 6 weeks until 5-7mg daily. Maintenance dose 5-7mg daily for 12 months provided symptoms controlled. Subsequently prednisolone can be reduced by 1mg every 6-8 weeks.