Monitoring

Patients may be followed on a monthly basis with routine blood ESR and/or CRP levels; however, evidence supporting this is limited. Once symptoms have resolved and the patient is on a stable tapering regimen, follow-up visits can be extended to every 3 months.

Treatment response is typically monitored by history, examination findings, and laboratory levels. This routinely includes evaluation of:

  • scalp tenderness

  • temporal artery tenderness

  • peripheral joint manifestations

  • ESR and/or CRP levels.

Signs and symptoms of giant cell arteritis (GCA) should be monitored as well, because GCA may manifest itself when the corticosteroids are tapered.[9]

ESR monitoring

There is conflicting support for ESR monitoring. Some clinicians monitor levels at baseline and every several months to assess treatment response and recurrence. A decline indicates a response.

Patients are seen once a month for the first 3 to 6 months. If the patient is symptom-free with a corticosteroid taper, levels are checked every 2 to 3 months. If there is a history suggesting possible symptom recurrence, the ESR is measured. Patients with an elevated ESR at diagnosis have a higher risk of more than 1 relapse.[28][29][48]

Treatment-related complications

Regular follow-up should also include monitoring for treatment-related adverse effects. In patients receiving corticosteroids, monitor for signs of infection, hypertension, muscle weakness, cataract development, glaucoma, and skin changes.

Patients receiving methotrexate need to be assessed for stomatitis, any respiratory changes (new cough, shortness of breath, dyspnea on exertion, new crackles on auscultation) that suggest the development of interstitial lung disease, LFT abnormalities (>2x normal), and myelosuppression. Evaluation for these methotrexate-related adverse effects should occur 1 month after any methotrexate dose increase and every 3 to 4 months in patients on a stable dose. The presence of any of these adverse effects requires further evaluation and either dosage reduction or discontinuation of the methotrexate.

In patients receiving tocilizumab, measure aminotransferase (ALT) and aspartate aminotransferase (AST) levels every 4-8 weeks during the first 6 months of treatment. After the first 6 months, levels can be monitored every 12 weeks.[56]

Ultrasound

The use of ultrasound to monitor the decrease in shoulder joint, shoulder periarticular structure, and hip joint inflammatory changes may be helpful in monitoring the response of PMR to corticosteroids.[64]

Use of this content is subject to our disclaimer