Treat-to-target Prednisolon Taper in Patients With Polymyalgia Rheumatica

Dose Reduction and Discontinuation of Prednisolone Using Structured Treat-to-target Taper in Patients With Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) has an incidence of approximately 1000/10^6 for persons more than 50 years. Treatment with prednisolone carries several significant adverse effects, and it is therefore essential to taper prednisolone as fast as possible. Systematic treatment strategies (treat-to-target) is the most important improvement of disease management for other rheumatic diseases such as rheumatoid arthritis in the last decades. Thus, the purpose is to investigate benefits and harms associated with a nurce led systematic prednisolone taper strategy at the department of rheumatology compared to individual treatment by discretion of the general practitioner. It is a 1-year open label randomised trial with a 1-year extension in 120 treatment naïve patients with PMR.

Inclusion Criteria:

• Patients newly diagnosed with PMR according to the EULAR criteria for PMR.
• No sign of GCA on ultrasonography of the temporal and axillary arteries.
• Age over 50 years.
• Danish spoken and written language skills sufficient to fill out questionnaires.

Exclusion Criteria:

• Peroral, intraarticular or intramuscular application of glucocorticoids within the last month.
• Previous prednisolone treatment for GCA/PMR.
• Unable to give consent.
• Symptoms of GCA (newly onset-headache, tenderness of the temporal artery, jaw claudication, vision disturbances).
• Active malignant cancers within the last 5 years (except basal cell carcinoma).
• Other inflammatory rheumatic diseases (eg. rheumatoid arthritis, polymyositis, spondyloarthritis, psoriatic arthritits, gout).
• Uncontrolled diseases (eg severe active asthma, cardiac disease with NYHA class IV)