Follow - up and monitoring of patients with polymyalgia rheumatica (PMR)

follow-up of patients with polymyalgia rheumatica

Vigilant monitoring of patients with PMR for response to treatment and disease activity is important:

• follow-up schedule:
  • follow up visits should be arranged at weeks 0, 1-3, 6, Months 3, 6, 9, 12 in first year (with extra visits for relapses or adverse events).
  • early follow-up is necessary as part of the diagnosis to evaluate response to initial therapy, and the first follow-up should occur at 1-3 weeks before commencment of steroids
    
    
• clinical assessment: At each visit, patients should be assessed for the folowing
  
  • response to treatment: proximal pain, fatigue and morning stiffness - It is important to distinguish between symptoms due to inflammation and those due to co-existing degenerative problems
  • complications of disease including symptoms of GCA, e.g. headaches, jaw claudication and large-vessel disease
  • steroid-related adverse events
  • atypical features or those suggesting an alternative diagnosis
    
    
• laboratory monitoring
  • full blood count
  • ESR/CRP
  • urea and electrolytes
  • glucose
    
    
• duration of treatment and follow-up:
  • usually 1-3 years of treatment, although some will require small doses of steroids beyond this. Flexibility in approach is necessary given the heterogeneous nature of disease. Steroids may be stopped when the patient is asymptomatic from their inflammatory symptoms.
  • isolated raised ESR or CRP is not an indication for continuing steroid therapy but may require investigation and referral
  • persistent pain may arise from co-existing OA and rotator cuff tears (1)

Reference:

• (1) Dasgupta B et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford). 2010;49(1):186-90.