Polymyalgia rheumatica is a disease in which cortisone must be given, especially because of the risk of complications! If temporal arteritis is also present, a starting dose of 80 mg to 100 mg prednisolone equivalent is needed; in uncomplicated PMR, a starting dose of 30 mg to 40 mg is usually sufficient. After starting cortisone therapy, symptoms typically improve dramatically almost immediately (within a few hours to a few days), and the laboratory inflammation markers fall significantly. The good response to cortisone can be regarded as an additional diagnostic criterion. The cortisone dose is then gradually reduced while monitoring laboratory values and how the patient feels. After a few weeks, a dose is usually reached that is below the threshold dose (Cushing threshold) at which the well-known cortisone side effects occur. Below this threshold, which is about 5 mg to 7.5 mg prednisolone equivalent, therapy can be continued for the necessary period, usually 1 to 3 years. Taking a calcium/vitamin D supplement at the same time is recommended to minimise the risk of osteoporosis, which is low at this dose. If it is not possible to reduce the dose below the Cushing threshold, additional treatment with an immunosuppressant is recommended. Azathioprine (e.g. Imurek) and methotrexate are medicines that are also used in rheumatoid arthritis or systemic lupus erythematosus. These medicines can save cortisone, and in most cases it is then possible to reduce the dose to the desired range. However, the effectiveness of azathioprine and methotrexate in temporal arteritis has not been proven.
