Intravenous glucocorticosteroids in PMR

Bhaskar Dasgupta

Do we use intravenous glucocorticosteroids in patients with polymyalgia rheumatica (PMR)? What are the doses of intramuscular glucocorticosteroids in these patients?

Bhaskar Dasgupta: We do not use intravenous. Intravenous glucocorticoids are mainly limited to when we are treating giant cell arthritis or large vessel vasculitis, where the patient is presenting with ischemic symptoms, and then we are trying to prevent ischemic sight loss and ischemic optic neuropathy.

So we do not use intravenous steroids in PMR. What we do is intramuscular methylprednisolone. We start with 120 mg, and we give depomethylprednisolone in the intramuscular region, gluteal region. For the first 3 months, the patients will be receiving 3 weekly injections, then after 3 months they will get monthly injections, and every 3 months we reduce the dose of steroids by 20 mg. So they will get 120 mg for 3 months, then 100 mg monthly for another 3 months, 80 mg monthly for another 3 months, and so forth. And we use a single 120 mg injection for a flare of PMR.

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