Este protocolo abrange o cenário clínico em que um paciente com polimialgia reumática não alcançou remissão com a terapia com glicocorticoides e requer uma abordagem estruturada de segunda linha.
A linha anterior com glicocorticoides não atingiu seu alvo primário: remissão definida como ausência de sintomas clínicos e inflamação sistêmica, com normalização dos reagentes de fase aguda — particularmente VHS e PCR. O não cumprimento deste alvo é o gatilho de escalonamento para o protocolo atual.
Remissão sustentada: ausência completa de sintomas clínicos juntamente com normalização dos reagentes de fase aguda, particularmente VHS e PCR.
DOI: 10.1136/ard-2022-223429
Methotrexate, in combination with GC, can be considered in the treatment of patients with GCA and PMR, even though data from clinical trials revealed conflicting results.
Once remission is reached, it should be maintained with the minimal effective dose of medication; drug-free remission may be achieved in a proportion of patients.
Achieving the minimal effective dose of medication is an important goal, and tapering-off GCs may have a higher priority than discontinuing disease modifying antirheumatic drugs (DMARDs), if both drugs are used in combination.
The treatment target of GCA and PMR should be remission; remission is the absence of clinical symptoms and systemic inflammation.
They most commonly include the absence of clinical symptoms related to GCA and/or PMR and the normalisation of acute phase reactants, particularly ESR and CRP.
Disease activity in GCA and PMR should be monitored regularly, as frequently as every 1–4 weeks until remission has been achieved, and at longer monitoring intervals (eg, between 3 and 6 months) in patients in stable remission on therapy; monitoring of patients off therapy should be discussed on an individual basis.
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