𝗧𝗵𝗲 𝟮𝟬𝟮𝟲 𝗕𝗿𝗶𝘁𝗶𝘀𝗵 𝗦𝗼𝗰𝗶𝗲𝘁𝘆 𝗳𝗼𝗿 𝗥𝗵𝗲𝘂𝗺𝗮𝘁𝗼𝗹𝗼𝗴𝘆 (𝗕𝗦𝗥) 𝗴𝘂𝗶𝗱𝗲𝗹𝗶𝗻𝗲 𝗳𝗼𝗿 𝘁𝗵𝗲 𝘁𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗼𝗳 𝗽𝗼𝗹𝘆𝗺𝘆𝗮𝗹𝗴𝗶𝗮 𝗿𝗵𝗲𝘂𝗺𝗮𝘁𝗶𝗰𝗮 (𝗣𝗠𝗥) (𝗧𝗼𝘆𝗼𝗱𝗮 𝗲𝘁 𝗮𝗹., 𝗥𝗵𝗲𝘂𝗺𝗮𝘁𝗼𝗹𝗼𝗴𝘆 𝟮𝟬𝟮𝟲) 𝗢𝘃𝗲𝗿𝗮𝗿𝗰𝗵𝗶𝗻𝗴 𝗣𝗿𝗶𝗻𝗰𝗶𝗽𝗹𝗲𝘀 These are mostly strong recommendations based on low-certainty evidence (expert consensus/good clinical practice): ◦ Decisions about clinical management should be shared between the clinician and the person with PMR, incorporating individual preferences and clinical risk profile. ◦ Care should be individualized and adjusted to the disease course, comorbidities, and treatment side effects. ◦ Management across the disease course should be delivered by individuals within a clinical team with appropriate knowledge and experience, aiming for continuity of care where possible. ◦ People with PMR should be managed primarily in primary care, with support from secondary care when indicated by clinical complexity, diagnostic uncertainty, or suboptimal treatment response. ◦ Consider discussing with rheumatology after any relapse (e.g., via established pathways such as NHS Advice and Guidance). Refer to rheumatology in the event of a second relapse (or after prolonged GC therapy, e.g., >18 months in some pathways). ◦ People receiving GC therapy should be reviewed periodically according to need by a healthcare professional. ◦ All people with PMR must receive clear and accessible education about their condition and management plan, including potential benefits, risks, and side effects of treatments. ◦ People should have access to educational materials and support, including information on self-care (diet, physical activity, and pacing). ◦ People should be supported to recognize and report symptoms that might relate to relapses of PMR, treatment toxicities, or other conditions including giant cell arteritis. 𝗞𝗲𝘆 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗥𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗮𝘁𝗶𝗼𝗻𝘀 These use GRADE methodology (S = strong; C = conditional; evidence certainty L = low or M = moderate): ◦ Treat newly diagnosed PMR with 12.5–15 mg prednisolone daily, increasing to a maximum of 25 mg daily if needed for symptom control. After symptoms are controlled for 2–4 weeks, begin tapering. (C, L) ◦ Prescribe bisphosphonates for people starting GC therapy unless contraindicated. (S, M) ◦ Once disease activity is sufficiently controlled, taper prednisolone by 2.5 mg every 2–4 weeks until reaching 10 mg daily, then by 1 mg every 4–8 weeks. (C, L) ◦ In people at high risk of GC toxicity, consider a faster taper once controlled (e.g., reducing by 1 mg every 2–3 weeks), aiming for discontinuation within about 6 months of initial control. (C, M) ◦ If PMR relapses, return to the last effective dose for 2–4 weeks, then consider slowing the taper based on individual factors. (S, L) ◦ Discuss with people recently diagnosed the option of referral to rheumatology to consider adding methotrexate to GCs, with the aim of reducing symptoms and stopping steroids sooner. (C, M) ◦ Consider adding methotrexate alongside GCs in people who have relapsed or are at higher risk of GC toxicity. (C, L) ◦ Consider adding an IL-6 receptor antagonist alongside GCs in people with an inadequate response to GCs or who are unable to tolerate a taper. (C, M) *Toyoda T, O’Brien AV, Boland C, Jones C, Wallace D, van der Windt DA, et al. The 2026 British Society for Rheumatology guideline for the treatment of polymyalgia rheumatica. Rheumatology (Oxford). 2026;65(10):keag502. 🔗doi.org/10.1093/rheumatology…