Polymyalgia rheumatica and corticosteroids: how much for how long?

In a prospective study of 176 patients in whom polymyalgia rheumatica (PMR) or giant cell arteritis (GCA) had been diagnosed between 1968 and 1980 the effect of corticosteroid treatment was studied. In those with PMR alone an initial regimen of 10 mg prednisolone daily and for the majority of those with GCA 20 mg daily were adequate to control symptoms. No patient suffered a serious disease complication after starting treatment. Regular follow-up enabled the minimum effective corticosteroid dose to be used. Complications of treatment were infrequent. Corticosteroid treatment has been withdrawn from 72 patients after a mean of 31 months treatment (range 3-103 months). Thirty subsequently relapsed, all within 21 months of withdrawal. No clinical feature predicted those who were more likely to relapse. No rigid treatment schedule should be used in these diseases.