There is no known way to prevent polymyalgia rheumatica (PMR). However, symptoms respond very well to treatment, and patients can usually return to their previous level of function.

Even without treatment, symptoms typically disappear after several years. With treatment, symptoms are often under control in just in few days, but they may recur if treatment is stopped too soon. If the symptoms do not disappear after a week of treatment, physicians will typically explore other possible diagnoses. Even after symptoms disappear, a minimum dose (maintenance dose) of medication is required for an extended period of time to suppress the disease.

Treatment focuses on reducing or eliminating the symptoms of PMR with a minimum of drug-induced side effects. Physicians may use blood tests during treatment to monitor the signs of PMR and adjust medication.

The most commonly prescribed medications for PMR are corticosteroids. In fact, some physicians consider the swift response of symptoms to corticosteroids among the criteria for the diagnosis of PMR. These are used to treat both PMR and temporal arteritis (a condition that causes arteries, particularly those in the head, to swell), but are used in higher doses for temporal arteritis.

Low doses of corticosteroids are used, especially if PMR is manifesting without the accompaniment of temporal arteritis. Often, patients report improvement after the first of these low-dose corticosteroids. If symptoms remain, doses may be increased for up to a week. As symptoms disappear, the dose is gradually reduced to the lowest effective dose.

Dosage must be reduced gradually because these drugs alter the body’s natural production of certain hormones. Stopping the medication suddenly can make a person very sick. Most people can stop taking corticosteroids in six months to two years, but treatment is occasionally prolonged beyond this. Corticosteroids may have negative long-term effects, including an increased risk of developing diabetes and a loss of bone density that may result in osteoporosis and fractures.

Regular follow-up appointments are important during and after treatment to catch any signs of relapse. If relapse occurs after corticosteroid therapy has ended, treatment will usually be restarted. As many as half of all PMR patients may experience a relapse. It is more common if the reduction of the corticosteroids occurs too quickly. It may be less common if other agents, such as those detailed below, are used along with the corticosteroids. However, treatment with other medications and corticosteroids remains a controversial point among physicians.

Even with low doses, corticosteroid treatment may result in numerous side effects (e.g., osteoporosis, increased blood pressure). These are typically mild in the low doses used in the treatment of PMR but do remain a concern. All side effects should be reported to a physician. It is recommended that all patients on corticosteroids take calcium and vitamin D supplements to reduce the risk of osteoporosis.

Other medications that may be used in the treatment of PMR include:

• Antimetabolites. Slow the growth of certain cells. The addition of these drugs may control symptoms among patients at high risk of corticosteroid-induced side effects while the steroids are being reduced. This has also been suggested to reduce the rate of relapse. However, most PMR patients who are not also suffering from temporal arteritis, a condition often associated with PMR, do not need antimetabolite therapy.
  
  
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Used alone, NSAIDs may provide a lesser degree of relief of PMR symptoms. They must be taken daily, although long-term use may damage the stomach or kidneys or have other side effects. In most cases, NSAIDs alone are not enough, but they may be added to corticosteroid therapy.

Although the symptoms of PMR respond very well to proper medication, patients may wish to take certain other factors into consideration:

• Exercise. Important to maintain joint flexibility and muscle strength and function. Exercise may be particularly useful in dealing with possible drug-induced side effects. Low-impact exercises (e.g., swimming, walking, tai chi) and stretching are usually emphasized. It is important to start slowly and work up gradually, particularly if the patient is not used to regular exercise.
  
  
• Nutrition. May help prevent potential problems associated with use of corticosteroids, such as thinning bones, high blood pressure and diabetes. Proper nutrition can also support the immune system. Fresh fruits and vegetables, whole grains and lean meats and fish are emphasized, as well as foods with plenty of calcium and vitamin D. Salt, sugar and alcohol are limited.
  
  
• Pacing. Physicians recommend that strenuous and/or repetitive tasks be alternated with easier ones to prevent muscle strain and fatigue. Plenty of rest is also important. This includes an adequate amount of sleep every night and rest time during the day. Occupational therapy may be prescribed to assist patients with energy conservation, task simplification and posture and ergonomics.