Dumfries & Galloway Health Board
Prescribing Support Team

Review of steroid prescribing in Polymyalgia Rheumatica (PMR)

Posted: 9 Dec 13 Edited: 14 Aug 18

The aim of this audit is to review steroid prescribing in patients with a diagnosis of PMR and highlight patients who require review of side-effects, patient on higher doses for a significant period without step-down, lack of co-prescription for bone protecting agents or gastrointestinal protection, or patients who have been taking oral or IM steroids for greater than three years.

Synthetic glucocorticoid analogues (i.e. prednislone, budesonide, dexamethasone) are generally used in clinical practice due to their longer half-lives, lower mineralocorticoid action and greater anti-inflammatory potency. Use of glucocorticoids in the evening inflicts greater attenuation of the early morning ACTH surge; therefore where possible glucocorticoids should be administered as a single dose in the morning. The rate of reduction in glucocorticoid dosage to physiological equivalents, and whether glucocorticoids should be fully withdrawn is generally dependant on activity of the disease being treated. PMR is one of the commonest reasons to prescribe long-term steroid therapy. Long term glucocorticoid therapy is however associated with a number of adverse effects including diabetes, hypertension, loss of bone mass and somatic changes characteristic of Cushing’s syndrome.