How long should prednisone be continued in Polymyalgia Rheumatica?
Tapering of the prednisone is based on the patient’s clinical response. PMR symptoms and ESR/CRP are the most reliable parameters to follow. The CRP normalizes more quickly than the ESR, which should decline to normal within 1 month. Failure to normalize these acute-phase reactants should prompt a search for occult GCA or an alternative diagnosis. Once normalized, a common strategy is to decrease the prednisone dose by 2.5 mg every 2 to 4 weeks until a dose of 10 mg/day is attained. Further tapering of prednisone occurs by 1 mg every 1 to 2 months while monitoring the patient and ESR or CRP. During the taper, a rise of ESR or CRP in an asymptomatic patient does not necessarily justify an increase in prednisone dosage. However, the dose should not be tapered further until alternative causes for the elevated acute-phase reactant have been investigated.
Optimally, the prednisone should be tapered and discontinued as quickly as possible because side effects are common (65% of patients). However, too rapid a taper can result in a relapse. If a relapse occurs, control is often regained by only a small increase in dosage. A slow taper can again be initiated, halting at a dose just above that at which relapse occurred. This is often 5 mg/day or less. Further tapering (1 mg every 2 months) is attempted again after a period of 6 months to a year.
