Hello @dnricketts, Welcome to Connect. You will notice that we moved your post to an existing discussion on the same topic here. If you click the link below it will take you to the beginning of the discussion where you can learn what others have shared.
--- PMR: Are there treatment alternatives to Prednisone?: https://connect.mayoclinic.org/discussion/alternatives-to-prednisone/.

Have you discussed your concerns of long term side effects of prednisone with your doctor or rheumatologist?

There is now an alternative to prednisone that was recently FDA approved for the treatment of PMR. It is a biologic called Kevzara (sarilumab).
https://www.pharmacytimes.com/view/fda-approves-sarilumab-for-adults-with-polymyalgia-rheumatica
I don't have any personal experience with Kevzara. My rheumatologist was running out of options for my long term PMR. The side effects of my 12 years on prednisone were taking a toll on me.

Other medications used as steroid sparing medications like methotrexate and leflunomide didn't work very well for me. My rheumatologist tried me on Actemra (tocilizumab) 4 years ago and it worked well. After more than 12 years of prednisone daily in excess of 10 mg, I am finally off prednisone. I'm still on Actemra so I'm not medication free. My rheumatologist thinks I'm better off on Acterma instead of prednisone. I would wholeheartedly agree!

The mechanism of action of Kevzara and Actemra is basically the same. Both biologics are IL-6 receptor blockers. IL-6 related inflammation is implicated in PMR and GCA.
https://www.pmrandil6.com/il-6-and-pmr/#:~:text=IL%2D6%20is%20implicated%20in%20the%20pathogenesis%20of%20PMR&text=However%2C%20persistently%20elevated%20IL%2D6,inflammatory%20conditions%20such%20as%20PMR.