Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are treated with oral glucocorticoids (GC) resulting in a rapid and complete response of symptoms in most cases. Early diagnosis and treatment of GCA is essential given that blindness and other ischemic complications usually occur before initiation of GC therapy.
Flares are common in PMR and GCA; duration of GC therapy usually lasts 1-3 years. In some cases, treatment may even be lifelong. GC related adverse events (AEs) frequently occur in PMR and GCA leading to a restriction of patients' quality of life and causing high economic burden. Immunosuppressive agents are thus warranted for treatment of PMR and GCA, particularly in patients with comorbidities that may be exaggerated by GC therapy and/or in case of risk factors for prolonged treatment being present. Methotrexate (MTX) has been recommended by the British Society of Rheumatology (BSR) for patients with relapsing PMR and GCA whereas EULAR suggests to consider MTX for every GCA case. Limited evidence is available for other conventional DMARDs such as azathioprine and leflunomide; these agents may thus be considered for treatment resistant cases. The role of biological agents is unclear: studies on infliximab failed the primary endpoint in PMR and GCA whereas etanercept led to a reduction of the cumulative GC dose in a study of GCA patients requiring ≥10mg/day oral prednisone to maintain remission. Tocilizumab yielded promising results in case reports/series of PMR and GCA, and this drug is currently being studied in a placebo controlled trial of GCA (GiACTA).
In this session, we will discuss the role of steroid sparing agents in the treatment of PMR and GCA presenting a clinical case as well as current evidence from randomized controlled trials.
Disclosure of Interest None declared