FAQ: Steroid-Sparing Agent Consideration in PMR Management & What Options Are Available?

July 2025

In this FAQ video, Claudia Rivera, NP, a rheumatology nurse practitioner from East Lansing, Michigan, discusses when to consider a steroid-sparing agent in the management of polymyalgia rheumatica (PMR) and what treatment options are available. While prednisone remains the cornerstone of PMR therapy, long-term steroid use poses significant risks including osteoporosis, diabetes, adrenal suppression, and infection. Claudia reviews guideline-based tapering strategies and highlights scenarios where steroid-sparing agents are clinically appropriate—such as glucocorticoid dependence, frequent disease relapses, or high risk for steroid toxicity. She explores commonly used agents like methotrexate, leflunomide, and azathioprine, as well as the 2023 FDA-approved biologic sarilumab (Kevzara), an IL-6 receptor antagonist. With a practical approach to dosing, side effect management, and patient selection, this video provides essential guidance for optimizing PMR care. For more educational content, visit RhAPP.org.