That is a good question!

I think most rheumatologists are reluctant to start elderly people on prednisone for reasons related to the side effects. The problem with PMR is that historically not many alternatives existed. It was prednisone by default because of the lack of a better option.

The potential for complications from the "long term" use of prednisone is true at any age so it isn't just a risk for the elderly. Treating PMR with prednisone is a long term proposition as my rheumatologist said at the start. She said I would need Prednisone for a couple of years. A couple of years can easily turn into 5 years ... 10 years or longer for many PMR sufferers who just happen to be elderly. I have often wondered how many people diagnosed with PMR end up taking Prednisone for the rest of their life???

In my opinion, there needs to be a better alternative to the long term treatment with prednisone for PMR especially for the elderly. The medical community is well aware of this problem. They aren't ignorant for wanting us to taper off prednisone as soon as possible and to take the lowest effective dose.

Technically ... I still have PMR according to my rheumatologist. My rheumatologist and I are very happy that I'm finally off Prednisone after 12 years. My treatment with Actemra has achieved remission of PMR and is also preventing PMR relapses which was something Prednisone didn't do so well in my case. It had nothing to do with how I tapered.

Prednisone is good for the rapid relief of pain while we wait for PMR to go into remission. It can be a long wait for remission to occur. The trade-off for rapid pain relief from Prednisone is the significant potential side effects, particularly with long-term use.