New rheumatic disease treatment lowers steroid dependence


Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease that can greatly reduce the ability to perform everyday activities such as getting out of bed, standing up from a chair, getting out of a car, bathing, or getting dressed. It’s estimated that one in every 1,200 people develop the condition every year and the typical case can last from one to five years, even with medication.

So, news that the FDA has approved Kevzara, a new drug that can replace the use – or reduce the duration of use – of prednisone, a powerful steroid, in treating PMR has been welcomed by the medical community, according to Dr. Sheetal Patel, a board-certified rheumatologist at Health First Medical.

Dr. Patel says that the onset of PMR usually takes one to two weeks, with pain and stiffness developing primarily in the shoulders and hips. Limited range of motion is another common symptom.

Data from Cleveland Clinic indicates the pain may also affect the upper arms, thighs and back, with both sides of the body affected equally.

Dr. Patel says treatment for the malady always starts with prednisone since it’s so fast acting and brings almost immediate relief to patients who begin to feel better in two or three days.

But prednisone brings a whole set of probable and possible side effects that make long-term usage dangerous. Side effects include:

  • Allergic reactions – skin rash, itching, hives, swelling of the face, lips, tongue or throat.
  • Cushing syndrome – increased fat around the midsection, upper back, neck, or face, pink or purple stretch marks on the skin, thinning, fragile skin that easily bruises, unexpected hair growth.
  • High blood sugar (hyperglycemia) – increased thirst or amount of urine, unusual weakness or fatigue, blurry vision.
  • High blood pressure.
  • Infection – fever, chills, cough, sore throat, wounds that don’t heal, pain or trouble when passing urine, general feeling of discomfort or being unwell.
  • Low adrenal gland function – nausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness.
  • Mood and behavior changes – anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression.
  • Stomach bleeding – bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds.
  •  Swelling of the ankles, hands or feet.

In addition, long-term use of prednisone almost inevitably results in the formation of cataracts.

So, it is not surprising that the FDA’s approval of a new biologic treatment option for patients with PMR was greeted with enthusiasm.

The injected drug Kevzara (sarilumab) is in a family of medicines known as interleukin-6 receptor blockers, which work by suppressing abnormal activity in the immune system that causes the body to attack healthy tissue. In clinical trials submitted to the FDA for approval, Kevzara was almost three times more effective in promoting symptom remission than a placebo.

The FDA OK’d Kevzara for testing in 2017 with final approval given in 2023. The suggested dosage is a 200mg injection under the skin once every two weeks with adjustments made as the doctor determines.

The specific causes of polymyalgia rheumatica are unknown, says Dr. Patel. It may be triggered by an infectious disease and some genetic predisposition is indicated, but studies continue to be done to learn more.

Mayo Clinic adds that environmental exposure may be involved, as new cases of PMR tend to come in cycles, possibly developing seasonally. This suggests that an environmental trigger, such as a virus, might play a role. But no specific virus has been shown to cause polymyalgia rheumatica.

The median age for people to develop PMR is 72, says Dr. Patel, with a very low chance of development for those under the age of 50. Women are twice as likely to get it as men and it is most common among white people whose ancestors were from Scandinavia or northern Europe.

There is no one specific test to diagnose polymyalgia rheumatica. Your doctor will do a physical exam, including joint and neurological exams, which can help him or her determine the cause of your pain and stiffness. Other tests may include blood tests and imaging tests such as MRIs and ultrasound to distinguish PMR from other conditions that cause similar symptoms.

Most people with this condition have high markers of inflammation. Other findings can include abnormal levels of proteins in the blood, abnormal levels of white blood cells, and anemia.

Your doctor should also monitor you for signs and symptoms that can indicate the onset of giant cell arteritis, which shares many of the same characteristics as PMR but requires a different course of treatment.

Following treatment, most people can return to their previous levels of activity. However, if you’ve had a long stretch of limited activity, you might benefit from physical therapy.

Symptoms associated with polymyalgia rheumatica often disappear for periods of time (remission) and then reappear (exacerbation). These episodes may continue for about six months or up to six years. However, severe impairment or permanent disability, even after months or years, is rare.

Dr. Patel says that a healthy lifestyle is one of the best ways to protect yourself from a recurrence. Avoid inflammation that affects your immune system. Eating a healthy diet, staying hydrated, managing your stress level, getting enough sleep, and being physically active can all keep you at your peak level of good health.

Dr. Sheetal Patel is a board-certified rheumatologist at Health First Medical Group. She received a B.S. in biology at University of Massachusetts, her medical degree at Ross University School of Medicine, completed her residency at Henry Ford Hospital and completed a fellowship in rheumatology at Detroit Medical Center, Wayne State University.

She is board-certified in rheumatology and internal medicine. She sees patients at Health First Medical Group-Gateway, 1223 Gateway Dr., Melbourne: 321-576-0647.

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