Hospital may start iv methylpred (if it is complicated) or continue high dose oral steroids (if it is not complicated). Complicated = jaw or tongue claudication, visual symptoms, including amaurosis fugax.
On discharge, patient will stay on high dose oral steroid until resolution or normalisation of ESR (usually 4+ weeks) after which reduce the steroids as follows
Start bone protection- bisphosphonate + calcichew D3 at same time as steroid
It is usual to continue low dose oral steroids for 12-18 months. In some patients it is difficult to stop them after this period. If this is the case, then refer to a specialist so that alternative immuno-suppressants such as methotrexate can be tried
If shoulder pain continues, patient may have co-existing sub-acromial bursitis!
Remain vigilant for signs of GCA which occurs in about 5% of patients with PMR.
Giant cell arteritis requires treatment with much higher doses of prednisolone (e.g. starting with 60 mg) but even the low doses used in PMR may disguise symptoms