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Have you been able to taper prednisone with long lasting success?
Polymyalgia Rheumatica (PMR) | Last Active: Jun 17, 2023 | Replies (41)Comment receiving replies
@amak23 will you discuss going on one of the Biologicals?
This is the first recommendation in this recent manuscript. I scan through the authors to see who are the players in the this field. I wonder how different will be the policies in US vs Europe.
Recommendation 1
The treatment target of GCA and PMR should be remission; remission is the absence of clinical symptoms and systemic inflammation.
https://bmj.altmetric.com/details/142886735/news this link shows which news outlets picked up this article.
"Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica
first author : Christian Dejaco"
WHAT IS ALREADY KNOWN ON THIS TOPIC
There is large heterogeneity in clinical practice related to treatment strategies in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).
The concept of treat-to-target (T2T) is widely adopted in rheumatology, but has yet not been defined for these diseases.
WHAT THIS STUDY ADDS
Here, we present consensus-based recommendations on T2T in GCA and PMR developed by an international, multidisciplinary task force.
Treatment targets, as well as strategies to assess, achieve and maintain these targets, have been provided.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
These recommendations advise clinicians how to effectively implement a T2T approach for GCA and PMR in clinical practice.
Gaps in current knowledge have been identified and a research agenda frames the needs to be addressed by future studies in the field.
Replies to "@amak23 will you discuss going on one of the Biologicals? This is the first recommendation in..."
Thank you for this information. I plan to bring it up for discussion.
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This link shows all six of the recommendations for a treat-to-target (T2T) approach to treat PMR and GCA. The recommendations are comprehensive.
https://ard.bmj.com/content/early/2023/02/23/ard-2022-223429
Box 1 Research Agenda: Shows there is a lot of work that needs to be done.
I try to advocate for Recommendation 1. Unfortunately, there isn't even a consensus on what remission is.
I can say Actemra worked infinitely better for me at least. That would be in contrast to my 12 years on prednisone.
I think there is room for improvement on the present standard of care as the following paragraph from the article suggests:
"Glucocorticoids (GC) are the standard treatment for GCA and PMR. Unfortunately, GC-related toxicity occurs in up to 85% of patients.1 2 In addition, many patients have pre-existing comorbidities that may worsen with GC therapy. Moreover, the prevalence of symptomatic disease relapse is high: in cohort studies, 34–62% of people with GCA and/or PMR were reported to have at least one relapse"
I don't know what is wrong with the following statement other than it seems difficult to achieve with the current standard of care.
"The treatment target of GCA and PMR should be remission; remission is the absence of clinical symptoms and systemic inflammation."