Twenty First Century Treatments for a Nineteenth Century Disease: Polymyalgia Rheumatica

Abstract

Objective: Polymyalgia Rheumatica (PMR) was first described in the 19th century in five elderly men in the Scottish spa at Strathpeffer by Dr. William Bruce [1]. The treatment of this common, painful, disabling condition has been corticosteroids virtually since these were first introduced to clinical practice 70 years ago [2]. This condition is the commonest reason for long term use of corticosteroids in the elderly. The side-effects of these agents are severe, and this is especially true in older age groups. The recent introduction of biological Disease Modifying Antirheumatic Drugs (DMARDs) and newer synthetic DMARDs has raised hope that effective treatment of PMR can be offered, and the serious side-effects of traditional steroid treatment circumvented. This review offers a summary of recent attempts to use these new antirheumatic agents. Methods: The authors searched Medline and PubMed using the search items polymyalgia rheumatica, giant cell arteritis and temporal arteritis over the past fifteen years. As much as possible, this search focused on treatment of PMR and Giant Cell Arteritis (GCA) with corticosteroids and newer synthetic and biological DMARDs where outcomes including toxicity and side-effects could be assessed. Results: The reports in the literature of the exhibition in PMR of a wide range of treatments including the newer organic and biological DMARDs have been reviewed. To date no entirely satisfactory alternative to corticosteroids for the control of this disease has been reported. Conclusion: Some of the newer DMARDs have shown promise in the management of PMR but, to date, no agent has been found adequate to replace the use of corticosteroids in the treatment of this disease.