A. Prednisone. Initial therapy for PMR is usually 10 to 15 mg of prednisone daily. A prompt and dramatic clinical response is considered by some to be an absolute criterion for the diagnosis. Most symptoms resolve in 48 to 72 hours, and the ESR should normalize after 7 to 10 days. Unusually, a patient who fails to respond to prednisone may respond to another corticosteroid, such as methylprednisolone or dexamethasone. If a dramatic response does not occur after several days, steroids should be discontinued. Following control of symptoms, the dose of corticosteroids should be reduced to the lowest level required to suppress symptoms, as the morbidity associated with therapy often exceeds that of the underlying disease. The dose of prednisone should be increased only for a recurrence of symptoms, not for an elevation of the ESR alone. Consideration should be given to ensure an adequate calcium intake in these elderly patients on corticosteroids who are at risk for corticosteroid induced osteoporosis (see Chapter., ..4.6,).
Low-dose corticosteroid therapy for PMR is not appropriate for patients with features suggestive of TA (see second section of chapter).
B. Nonsteroidal antiinflammatory agents may suppress rheumatic symptoms, but they do not reduce the risk for blindness if TA is present.
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