skip to main content

PMR Steroid-Sparing Therapy — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateVasculitisPMR Steroid-Sparing TherapySCE Rheumatology

A 65-year-old woman with PMR on Prednisolone 7 mg daily has relapsing symptoms with bilateral shoulder stiffness and raised ESR whenever the dose is reduced below 7 mg. She has been on steroids for 18 months. According to BSR guidelines what steroid-sparing agent can be considered for relapsing PMR?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Methotrexate may be considered as a steroid-sparing agent for relapsing PMR though evidence is modest

BSR PMR guidelines acknowledge that Methotrexate (7.5-10 mg weekly) may be considered as a steroid-sparing agent in patients with relapsing PMR or those experiencing significant glucocorticoid side effects. The evidence is modest (from small trials including Caporali et al 2004) showing reduced relapse rates and lower cumulative steroid doses. Tocilizumab has shown promise in PMR (PMR-SPARE study) but is not widely commissioned for this indication in the UK. Azathioprine and Leflunomide have also been used anecdotally. The decision should weigh the risks of continued glucocorticoid exposure against the modest evidence for steroid-sparing agents.

Reference: BSR 2010 PMR guidelines; Caporali R et al 2004 MTX in PMR