How should I approach the initial management of a patient diagnosed with Polymyalgia Rheumatica?

Initial management of Polymyalgia Rheumatica (PMR) involves starting oral prednisolone at a dose within the range of 12.5 mg to 25 mg daily, tailored to the individual's risk of relapse and comorbidities. A typical starting dose is 15 mg daily until symptoms are fully controlled, usually within 3 weeks.

After symptom control, prednisolone should be tapered slowly: reduce to 12.5 mg daily for 3 weeks, then to 10 mg daily for 4–6 weeks, followed by gradual dose reductions of 1 mg every 4–8 weeks until discontinuation, provided remission is maintained.

Rapid withdrawal of corticosteroids should be avoided to prevent adrenal insufficiency and relapse. Treatment usually lasts between 1 and 2 years.

Patients must be provided with a steroid treatment card and advised not to stop prednisolone abruptly. They should be informed about potential adverse effects and the importance of avoiding exposure to infections like chickenpox, shingles, or measles if not immune.

Routine reviews should be arranged one week after any dose change and at least every 3 months during the first year. At reviews, assess symptoms of relapse, giant cell arteritis, and corticosteroid side effects.

Referral to specialist care is indicated if corticosteroids cannot be tapered without relapse, treatment is needed for more than 2 years, or if adverse effects occur.