Treatment and prognosis in polymyalgia rheumatica and temporal arteritis. A ten-year survey of 53 patients.

. The course of the disease and the effect of corticosteroid treatment were studied in 53 patients in whom polymyalgia rheumatica (PMR) or temporal arteritis (TA) had been diagnosed between 1967 and 1977. The mean interval between the onset of symptoms and confirmation of the diagnosis was 7 months. The starting dosage of prednisolone was 30–40 mg daily for patients with evidence of cranial arteritis and 10–20 mg daily for those without. The mean daily maintenance dose of prednisolone was 7.5 mg, usually 5 mg for patients with uncomplicated PMR and 10 mg for patients with TA. Only 7 (16%) patients with symptoms due to PMR continued to feel well and had no relapse of symptoms on 2.5 mg prednisolone daily. Corticosteroids were withdrawn from 19 patients 1 month to 4 years (mean 16 months) after the start of treatment. By 1977, 34 patients had received prednisolone continuously for 8 months to 9 years (mean 3 years). Attempts to witdraw cortico-steroids provoked 33 relapses in 20 patients, and 21 patients had a total of 33 relapses while on maintenance dosage. In 5 of the latter a definite relapse of clinical symptoms was not accompanied by a concomitant rise in ESR. No serious complications of the disease occurred in this series after the start of therapy, and complications attributable to treatment were infrequent. The duration of the active stage of the disease varies widely. It is rarely advisable, however, to end treatment with corticosteroids before the end of 1 year, and most patients need such treatment for at least 2–3 years.