INITIATING prednisolone treatment before rheumatological assessment may significantly hinder the ability to accurately diagnose polymyalgia rheumatica (PMR).
The Danish study, which included data from 93 individuals (66 with confirmed PMR and 27 with non-PMR conditions), examined how prednisolone initiation and short-term discontinuation affect clinical diagnosis. It found that PMR was diagnosed with high accuracy in treatment-naïve patients, but this clarity dropped dramatically after starting steroids.
At baseline, before treatment, six blinded rheumatologists reviewing clinical case reports were able to differentiate PMR from non-PMR patients with a sensitivity of 85.9% and specificity of 82.7%. However, after just 8 weeks of prednisolone treatment, the sensitivity plummeted to 3.5%, and only slightly improved to 25% after a short discontinuation of therapy at 10 weeks.
“This highlights a key challenge in PMR management,” said lead author Christoffer S. Våben. “Initiating steroids too early masks the clinical features of the disease, making it significantly harder to confirm the diagnosis, even after a brief pause in treatment.”
The authors emphasise that their findings support current clinical guidelines advising that prednisolone should not be started until a specialist has evaluated the patient. As approximately 50% of patients with suspected PMR begin steroids before seeing a rheumatologist, the study raises concerns about premature treatment complicating diagnosis.
PMR, a common inflammatory condition affecting older adults, is typically characterised by pain and stiffness in the shoulders and hips. Steroids like prednisolone are the standard treatment, but starting them without a confirmed diagnosis could lead to mismanagement or delayed identification of other conditions.
Reference
Våben SC et al. The effect of prednisolone initiation and short-term discontinuation on the clinical assessment of polymyalgia rheumatica. Rheumatol. 2025;DOI: 10.1093/rheumatology/keaf170.
