Frequency, Diagnostics and Therapy for Relapses in Polymyalgia Rheumatica

There are no generally accepted criteria for the classification of a relapse in polymyalgia rheumatica (PMR). In clinical studies, a relapse was defined as "recurrence of PMR characteristic symptoms" with or without increment of acute phase reactants. Around 50% of PMR patients suffer at least one relapse episode during their disease course. Advanced age, female sex, elevated erythrocyte sedimentation rate, increased plasma viscosity, high serum levels of soluble interleukin (IL)-6 receptor and persistently elevated C-reactive protein levels were associated with a higher relapse risk. The initial glucocorticoid dose as well as the subsequent tapering regimen also seem to play a role. A relapse of PMR is treated with an increment of corticosteroids to the pre-relapse dose. According to the British Society of Rheumatology guidelines, the addition of methotrexate may be considered in patients with frequent recurrences.