When should I consider referring a patient with Polymyalgia Rheumatica to a rheumatologist?

Consider referring a patient with Polymyalgia Rheumatica (PMR) to a rheumatologist if:

• It is not possible to reduce corticosteroids at reasonable intervals without causing relapse.
• Corticosteroids are required for more than 2 years.
• The patient experiences repetitive flares of PMR symptoms.
• The patient is experiencing or is at high risk of adverse effects from corticosteroids.

Additionally, seek specialist advice if symptoms of PMR do not settle after increasing prednisolone to the previous effective dose following a relapse.

Routine reviews should be arranged one week after any change in prednisolone dose and at least every 3 months in the first year following diagnosis to monitor symptoms, adverse effects, and laboratory markers.

Urgent referral is indicated if symptoms of giant cell arteritis (GCA) develop.

These referral criteria are based on the British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guidelines and supported by EULAR/ACR recommendations.

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