Corticosteroid injections in polymyalgia rheumatica: a double blind, prospective, randomized, placebo controlled study

Objective. To determine the efficacy and safety of shoulder corticosteroid injections in polymyalgia rheumatica (PMR). Methods. Twenty consecutive patients with active PMR were randomized into a 7 month, double blind, placebo controlled study. Patients received either bilateral shoulder injections of 40 mg of 6-methyl-prednisolone acetate or placebo (1 ml saline solution). Responders were treated weekly with the sam e regimen for a total of 4 bilateral injections and then followed for G mon ths. Response was defined as a 70% reduction in visual analog scale (VAS) s core for pain and for patient and physician global assessment, and duration of morning stiffness. Bilateral shoulder magnetic resonance imaging (MRI) was per formed at different times to evaluate the response of lesions to th erapy. Results. All 10 corticosteroid treated patients responded to the first inje ction with a significant reduction in duration of morning stiffness, VAS pa in scale, patient and physician global assessment, erythrocyte sedimentatio n rate, and C-reactive protein. Interleukin G serum levels were significant ly reduced after the 2nd injection. In 5 patients, the response persisted t hroughout the followup period. The other 5 withdrew within 4 weeks after th e 4th injection due to recurrence of symptoms. None of the 10 patients of t he placebo group responded to the first injection. The difference between t he 2 groups was significant (p = 0.03). No side effects were recorded. MRI showed marked improvement of shoulder lesions one week after first injectio n and an almost complete resolution one week after last injection in the re sponders. Conclusion. Shoulder corticosteroid injections seem to be an effective and safe therapy for PMR.