Treatment of polymyalgia rheumatica with intramuscular injections of depot methylprednisolone

Article Abstract:

Polymyalgia rheumatica is characterized by severe pain and stiffness in proximal (close to the trunk) muscles without permanent weakness, and is twice as common in women. The disease is distinguished from rheumatoid arthritis by lack of arthritis in the hands or more than a couple of joints. In addition, diagnosis is confirmed when patients respond within 36 hours to steroid treatment, often prednisolone. Although low doses of prednisolone are sufficient to induce remission in most cases, treatment may be necessary for several years, potentially resulting in osteoporosis or other serious side effects. However, low doses result in a high incidence of relapse of the disease. Steroid administration which combined effectiveness with low total dosage would be a significant improvement. Methylprednisolone, a chemical relative of prednisolone, is more powerful in one of two steroid actions. It can be injected, and is available in a depot (storage) form, allowing less frequent administration. The outcome of 16 patients newly diagnosed with polymyalgia rheumatica who were treated with depot methylprednisolone was the subject of a preliminary study. Injections were given every three weeks for the first 12 weeks, and then treated monthly with progressively reduced doses. Doses were increased if symptoms escalated. Morning stiffness and pain resolved in all patients within two days after the first methylprednisolone injection. The erythrocyte sedimentation rate, a test which examines the rate at which red blood cells precipitate and which is an indicator of inflammatory disease, decreased fourfold over the first 12 weeks. Levels of native steroids were normal, indicating that therapy did not disrupt the hormonal balance, unlike effects observed from standard steroid protocols. Three patients returned to standard oral steroid treatment for varied reasons, only one because of increased disease severity. Minor bruising occurred in three patients after 12 months of therapy. The study indicates that depot methylprednisolone is safe and effective in treatment of polymyalgia rheumatica. The effect of such therapy on bone loss remains to be studied. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Dosage and administration, Methylprednisolone

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Genetic and environmental factors in polymyalgia rheumatica

Article Abstract:

A theory is proposed for explaining the triggering mechanisms and disease development of polymyalgia rheumatica (PMR). PMR is type of rheumatic disease. The theory draws on evidence from three disciplines including genetics, environmental science, and immunology. Evidence suggests that long-term sun damage to surface blood vessels, particularly among older women who carry the HLA-DRB1 gene, may provide a weakened entry point for a viral infection. A subsequent immune reaction could lead to the vessel damage seen in patients with PMR.

Environmental aspects

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