What are the potential side effects of corticosteroid treatment in patients with Polymyalgia Rheumatica, and how can they be managed?

Potential side effects of corticosteroid treatment in patients with Polymyalgia Rheumatica (PMR) include weight gain, dyspepsia, muscle weakness, skin thinning, easy bruising, increased blood pressure, and elevated blood glucose levels. Long-term corticosteroid use also raises the risk of osteoporosis and adrenal insufficiency if withdrawn too rapidly. These adverse effects are common due to the systemic nature of corticosteroids and their impact on multiple organ systems ¹.

Effective management of these side effects involves several strategies. Firstly, corticosteroid doses should be kept to the minimum effective amount, typically starting between 12.5 mg and 25 mg of prednisone equivalent daily, with careful dose tapering to avoid relapse and adrenal insufficiency. The dose should be tapered slowly, for example reducing to 10 mg daily within 4–8 weeks, then by 1 mg every 4 weeks or longer, tailored to individual response and side effect profile [1, (Dejaco et al., 2015)].

Regular monitoring is essential, including routine reviews one week after any dose change and at least every three months in the first year. Monitoring should assess symptoms of PMR relapse, signs of giant cell arteritis, and adverse corticosteroid effects such as weight gain, muscle weakness, skin changes, blood pressure, and glucose levels. Blood tests including full blood count, ESR/CRP, and renal function should be checked to distinguish inflammation from other causes of symptoms and to monitor for side effects ¹.

To reduce osteoporosis risk, assessment and management of fracture risk should be performed, including bone protection strategies as per osteoporosis guidelines. Patients should be provided with a steroid treatment card and advised not to stop corticosteroids abruptly to prevent adrenal crisis. Education about avoiding exposure to infections like chickenpox or measles is important due to immunosuppression ¹.

In cases where corticosteroid side effects are significant or corticosteroids are required for more than two years, referral for specialist management is recommended. Specialist input may include consideration of steroid-sparing agents or alternative therapies, as emerging literature suggests potential benefits from newer treatments to reduce corticosteroid burden (Iorio et al., 2025).

Overall, the management of corticosteroid side effects in PMR requires a balance between controlling inflammation and minimizing harm, achieved through individualized dosing, slow tapering, vigilant monitoring, patient education, and multidisciplinary care [1, (Dejaco et al., 2015); (Iorio et al., 2025)].