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Open Access Highly Accessed Research article

The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity

Marco A Cimmino1*, Massimiliano Parodi1, Carlomaurizio Montecucco2 and Roberto Caporali2

Author Affiliations

1 Clinica Reumatologica, Dipartimento di Medicina Interna, Università di Genova, Viale Benedetto XV, 6, 16132 Genova, Italy

2 IRCCS Policlinico S.Matteo, Pavia, Italy

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BMC Musculoskeletal Disorders 2011, 12:94  doi:10.1186/1471-2474-12-94

Published: 14 May 2011

Abstract

Background

the mainstay of treatment of polymyalgia rheumatica (PMR) is oral glucocorticoids, but randomized controlled trials of treatment are lacking. As a result, there is no evidence from controlled studies on the efficacy of different initial doses or glucocorticoid tapering. The aim of this study is to test if 12.5 mg prednisone/day is an adequate starting dose in PMR and to evaluate clinical predictors of drug response.

Methods

60 consecutive PMR patients were treated with a starting dose of 12,5 mg/day prednisone. Clinical, laboratory, and, in a subset of 25 patients, ultrasonographic features were recorded as possible predictors of response to prednisone. Remission was defined as disappearance of at least 75% of the signs and symptoms of PMR and normalization of ESR and CRP within the first month, a scenario allowing steroid tapering.

Results

47/60 (78.3%) patients responded to 12.5 mg of prednisone after a mean interval of 6.6 ± 5.2 days. In univariate analysis, body weight and gender discriminated the two groups. In multivariate analysis, the only factor predicting a good response was low weight (p = 0.004); the higher response rate observed in women was explained by their lower weight. The mean prednisone dose per kg in the responders was 0.19 ± 0.03 mg in comparison with 0.16 ± 0.03 mg for non responders (p = 0.007).

Conclusions

12.5 mg prednisone is a sufficient starting dose in ¾ of PMR patients. The main factor driving response to prednisone in PMR was weight, a finding that could help in the clinical care of PMR patients and in designing prospective studies of treatment.

Trial Registration

ClinicalTrials.gov: NCT01169597

Keywords:
polymyalgia rheumatica; prednisone; glucocorticoid; ultrasonography