[S2e guidelines on the treatment of polymyalgia rheumatica: update 2024 : Evidence-based guidelines of the German Society for Rheumatology and Clinical Immunology (DGRh), the Austrian Society for Rheumatology and Rehabilitation (ÖGR) and the Swiss Society for Rheumatology (SGR) and the participating medical scientific specialist societies and other organizations].

Abstract

Polymyalgia rheumatica (PMR) is part of a disease spectrum that includes giant cell arteritis and is the second most frequent inflammatory rheumatic disease in old age, after rheumatoid arthritis (RA). The S3 guideline on the treatment of PMR published in 2018 has now been updated in the form of S2e-guidelines. The basis for the update was a systematic literature search that covered the evidence published in the period July 2016 to January 2024 on therapeutic interventions and prognostic factors for PMR. The same clinical questions and search strings as in the literature search for the original guideline were used, with an extension to also include targeted synthetic disease-modifying antirheumatic drugs (DMARDs). Based on the evidence and expert opinions, the guidelines committee (12 physicians, 2 healthcare professionals and 2 patients from 3 countries) developed a total of 7 recommendations. In addition to updating the contents, some recommendations were restructured by summarizing or separating them with the aim of simplifying the applicability compared to the 2018 guidelines. It is still recommended to initiate treatment with glucocorticoids (15-25 mg prednisone equivalents per day) immediately after diagnosis and subsequently to taper these drugs while monitoring the disease activity and adverse effects of the treatment. Interleukin‑6 receptor blocking agents (alternatively, methotrexate or rituximab may be considered) should be used in addition to glucocorticoids in patients with relapsing disease, and these drugs can be considered in individual cases with new-onset PMR and high risk for glucocorticoid-related adverse events. Older and/or frail patients should be offered an individualized exercise program in addition to drug therapy. This updated guideline should serve as an aid to making evidence-based decisions in order to ensure standardized high-quality care for all patients with PMR.