Glucocorticoid treatment of polymyalgia rheumatica

Glucocorticoids are the mainstay of treatment in patients with polymyalgia rheumatica (PMR). Moreover, lower serum cortisol levels have been reported in patients with PMR, suggesting an important role of impaired hypothalamus-pituitary-adrenal (HPA) axis in the pathogenesis of the disease. Therefore, a good response to glucocorticoids has been recognised as a feature of PMR, even if disagreement remains concerning an exact starting dose, duration of treatment and schedule of administration. The role of glucocorticoids in the pathogenesis of PMR, as well as the available evidence concerning different schedules of glucocorticoid treatment, including administration according to circadian rhythms, are discussed.