PMR Relapse Percentage

[kp60]

I read that the relapse percentage for PMR is 50%. What say you the subject matter experts on PMR? I hope that's not right

[DorsetLady PMRGCAuk volunteer]

Probably depends on -

how you taper [and that is very often how your doctor instructs you],

how you manage you illness,

any outside factors beyond your immediate control [other health issues, family/work/environmental stresses]

I was treated for GCA for 4 & half years [undiagnosed for 18 months previously] - but never had a relapse once treatment started.

[SnazzyD]

I agree with DL. I do wonder how many people would have fared had they had a sensible/personalised tapering plan and useful information about the condition and the effects of Pred.

[PMRpro Ambassador]

Depends what you class as a relapse. As far as I can see in most papers they look at any return of symptoms during the tapering of the pred dose. Given the way some doctors tell patients to reduce the dose I'm surprised it isn't higher!

If you approach tapering as we recommend, the majority of patients would get through their journey with far fewer problems and even, like DorsetLady, without a relapse.

I personally class relapses as a return of PMR symptoms after a long period of not being on pred (more than 6 months). They are NOT that common.

[Koalajane]

what do you mean by relapse?

[kp60]

I guess having to restart Prednisone due to PMR symptoms returning

[DorsetLady PMRGCAuk volunteer in reply to kp60]

in response to Koalajane question this is what the BSR & BHPR guidelines say about relapses in the treatment

“(8) We recommend the following approach to relapse of disease.

Relapse is the recurrence of symptoms of PMR or onset of GCA, and not just unexplained raised ESR or CRP

Treatment of relapse:

The approach to diagnosis and management of PMR is summarized in Fig. 2.

 Clinical features of GCA: treat as GCA (usually oral prednisolone 40–60 mg daily) (see GCA guideline)

Clinical features of PMR: increase prednisolone to previous higher dose.

Single i.m. injection of methylprednisolone (depomedrone) 120 mg can also be used.

Further relapses: consider introducing DMARD therapy after two relapses”

[piglette]

Of the people I know personally I don’t know anyone with a relapse. I have noticed though that where people rush down to zero they regularly have a relapse probably due to the fact that the PMR never went into remission in the first place.