When Steroids Are No Longer Enough

Living with polymyalgia rheumatica (PMR) often feels like a balancing act. Many people with PMR start their journey with steroids like prednisone. Steroids can help the stiffness and pain feel better fast. However, steroids are not always a long-term fix. Many people find they cannot lower their dose without PMR symptoms coming back.¹

The steroid-dependency cycle

Many people with PMR face a frustrating "yo-yo" effect. Your doctor may try to taper your dose of steroids. Tapering means slowly taking less of the drug. At first, you may feel fine. Then, the stiffness and pain return. This is known as a flare. You must then go back to a higher dose to feel better.^1,2

It is important to know that this cycle is not your fault. It is not a sign of failure. Instead, it is a biological hurdle. Your body may have a hard time keeping inflammation down without the help of the drug.^1,2

This cycle of starting and stopping is called steroid dependency. If you have been on steroids for a long time, your body may need a different approach to find lasting relief.²

The risks of long-term steroid use

Staying on steroids for a long time can lead to health problems. Steroids affect the whole body, not just the parts that hurt. Doctors call these "cumulative impacts." This means the risks add up over time.²

Some common risks of long-term steroid use include:²

• Bone density loss – Steroids can make bones weak and brittle. This may lead to breaks.
• High blood sugar – These drugs can cause glucose intolerance. This makes it harder for your body to manage sugar.
• Skin thinning – You may notice your skin bruises or tears more easily.
• Weight gain – Many people find it hard to maintain their weight while on steroids.

A newer treatment option

To understand new treatments, it helps to know how inflammation works. In PMR, a protein called interleukin-6 (IL-6) acts like a messenger. It tells your body to feel stiff and sore. Steroids work like a "carpet bomb." They go everywhere in the body to stop inflammation. This is why they cause so many side effects.^2,3

A biologic drug works differently. It is like a "surgical strike." It targets only the specific protein that causes the problem. For PMR, this means blocking the IL-6 receptor. By blocking this receptor, the drug stops the message of pain and stiffness before it starts. This targeted approach helps manage PMR without affecting every other part of your body.³

There are many drugs used for other types of arthritis. However, PMR is a unique condition. For a long time, there were no biologic drugs specifically approved for it. In 2023, the US Food and Drug Administration (FDA) approved Kevzara® (sarilumab) for PMR.³

Kevzara® is the only biologic with this specific approval for PMR. This drug treats adults with PMR. It is for people who do not find enough relief with steroids. It is also for people who cannot handle lowering their steroid dose. Kevzara is given every 2 weeks as a subcutaneous (just under the skin) injection.^3,4

Kevzara has a boxed warning, the strictest warning from the FDA. It has this warning because it can increase the risk of serious infections. Talk to your doctor about what to expect when taking Kevzara.⁴

Questions to ask your doctor about your PMR treatment

If you are struggling to lower your steroid dose, it may be time to talk with your healthcare team. You do not have to live with the "yo-yo" effect forever. Here are some questions you can ask at your next doctor’s visit:

• I am struggling to taper my prednisone without a flare. Am I a candidate for biologic therapy?
• What are the risks of staying on my current dose of steroids for another 6 months?
• Would switching to Kevzara help my specific symptoms?

Before beginning treatment for PMR, tell your doctor about all your health conditions. Tell them about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

Talk with your doctor

Managing PMR is about more than just stopping the pain today. It is about protecting your health for the future. If steroids are no longer enough, you have other options. Targeted biologics offer a way to break the steroid cycle and protect your body from long-term side effects.³