Advances in the treatment of polymyalgia rheumatica

Abstract

Polymyalgia rheumatica (PMR) is a common inflammatory disorder affecting individuals over 50. The cornerstone of PMR treatment remains oral glucocorticoids (GCs), with initial doses tailored to the risk of relapse and comorbidities. However, relapses occur in up to 76% of cases, and long-term GC use is associated with significant toxicity, affecting up to 85% of patients. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), such as methotrexate, offer limited benefits, while recent evidence supports the use of biologics, such as tocilizumab and sarilumab, in reducing GC dependency and achieving remission. Emerging treatments, including JAK inhibitors (tofacitinib) and B-cell depletion (rituximab), show promise but require further validation. The treat-to-target (T2T) strategy is advocated for achieving sustained remission and minimizing adverse effects. New treatment options requiring rheumatological expertise are emerging, highlighting the need for specialized management, early referral, improved imaging use, and standardized definitions of remission and relapse to enhance patient care and outcomes.

Keywords: GCA-PMR spectrum disease (GPSD); JAK inhibitors; biologic DMARDs; conventional DMARDs; oral glucocorticoids (GCs); polymyalgia rheumatica (PMR); rituximab; sarilumab; target DMARDs; tocilizumab.