Course of a Polymyalgia rheumatica | Polymyalgia rheumatica

Course of a Polymyalgia rheumatica

The course of the Polymyalgia rheumatica depends on how quickly a therapy with cortisone is initiated. Untreated, the disease can cause symptoms for years. The complaints can occur in relapses.

Thus, phases of illness with few or no symptoms, as well as phases of illness with strong symptoms can alternate. If it occurs together with arteritis temporalis, there is a risk of blindness if left untreated. After starting drug treatment, the symptoms usually recede significantly after a few days. Not to be forgotten, however, are the side effects that can occur during cortisone therapy. Even though this therapy is very effective, cortisone therapy can lead to numerous undesirable effects such as osteoporosis, development of stretch marks, development of cataracts or glaucoma, diabetes mellitus, fat distribution disorders with formation of a full moon face or bull neck and immunodeficiency.

Treatment

As already mentioned, the therapy is carried out with the administration of glucocorticoids (cortisone). Their effect is mainly based on an anti-inflammatory effect, which reduces pain. Cortisone acts very quickly, so that the pain usually improves within hours to a maximum of days.

If the symptoms improve in the course of the therapy, the dose of the cortisone preparation can be reduced step by step, so that a dose can be reached at which there should be hardly any side effects. Under no circumstances should the dose be reduced too quickly, as the signs of inflammation and the pain will then immediately increase again. However, if the therapy does not have a direct effect or if its effectiveness diminishes, the dose must be increased again.

The therapy with cortisone should be carried out over a period of two years. This long therapy should reduce the risk of regression of the disease. In the past, the disease was treated with considerably higher doses of cortisone, so that although the disease was successfully treated, the patients then suffered from the consequences of cortisone therapy.

The side effects often led to the development of osteoporosis. Today, this usually no longer occurs due to the reduced dose. For the Vorbeugung typically all patients get calcium and/or Vitamin D preparations parallel to the Cortison therapy prescribed as standard for prophylaxis.

If the therapy does not work sufficiently can supporting Methotrexat be consulted, so that the dose of Kortison does not have to be increased excessively. Methotrexate suppresses the immune system, which leads to an improvement in symptoms due to the presumably autoimmune component of the disease. The dose of cortisone therapy differs depending on whether it is a pure polymyalgia rheumatica or a combination of polymyalgia and arteritis temporalis (also known as giant cell arteritis or Horton’s disease).

If arteritis temporalis is also present, a high dose of 100 mg cortisone per day is usually recommended.This is because of the risk of blindness in temporal arteritis. Such cortisone shock therapy in high doses is intended to prevent this. With a pure polymyalgia rheumatica, an initial dose of 20-30 mg of cortisone per day is usually sufficient.

It is taken in the morning, as the cortisol level in the body is highest and the intake is therefore most physiological. Cortisone therapy must usually be continued over a longer period of time. The aim, however, is to slowly reduce the dose as it progresses.

In polymyalgia with arteritis, the dose is reduced to 20-30 mg per day after two months at the earliest. If a pure polymyalgia rheumatica is present, the dose can usually also be reduced after about two months, for example to 10-15 mg per day. A further stepwise dose reduction is then carried out.

After about 6-9 months the dose can be reduced to below 7.5 mg per day. This is the threshold dose below which less serious side effects should occur in long-term cortisone therapy. A complete discontinuation (i.e. a further dose reduction until the therapy is completely discontinued) is usually attempted after two years at the earliest.

The therapy with cortisone is definitely the best therapy available for polymyalgia rheumatica. Nevertheless, many patients cannot be satisfied with a long cortisone therapy due to the side effects. Unfortunately, there is no reasonable or even rudimentary comparable alternative to the therapy with cortisone, so that a therapy with cortisone is actually unavoidable.

One alternative, although not cortisone-free, is to treat additionally with immunosuppressive drugs like methotrexate, so that a lower cortisone therapy can be used from the beginning. Especially in the initial phase, there is unfortunately no getting around cortisone therapy. There are many homeopathic remedies that can be used for the treatment of a polymyalgia rheumatica.

In the first place stands here Traumeel®, a substance which is to work entzündungshemmend. Also Aesculus Heel drops, Hamamelis-Homaccord drops or Arteria Heel drops can be used. However, the effect of homeopathic substances has not been scientifically proven.

Especially if it is a polymyalgia with additional arteritis temporalis, untreated it can lead to dangerous progressions, as in this case the eyesight can be acutely endangered. In this case a doctor of conventional medicine should be consulted as soon as possible. The only verifiably effective therapy for polymyalgia is a cortisone therapy.