Lunch Symposium 5

Objectives:

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease affecting adults aged 50 years and older, characterized by bilateral pain and stiffness in the shoulder and pelvic girdles and a substantial impact on physical function and quality of life. Despite its relatively high prevalence, PMR remains a challenging condition due to heterogeneous clinical presentation, frequent diagnostic uncertainty, and a chronic or relapsing disease course in many patients. The disease burden extends beyond musculoskeletal symptoms, leading to prolonged disability, reduced independence, and increased healthcare utilization.

Current diagnosis and management are guided by the 2015 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) recommendations, which emphasize clinical assessment supported by inflammatory markers and imaging where appropriate. Glucocorticoids remain the standard first-line therapy and are highly effective in achieving rapid symptom control. However, long-term glucocorticoid exposure is often associated with significant adverse effects, particularly in elderly patients, including osteoporosis, metabolic complications, infections, and increased cardiovascular risk. Accordingly, guidelines recommend the lowest effective dose and highlight the importance of glucocorticoid-sparing strategies.

Despite guideline-based care, major unmet needs persist in PMR management. These include delayed diagnosis, lack of validated biomarkers for disease activity and remission, high relapse rates during glucocorticoid tapering (40~50% at 1 year), and limited therapeutic options for patients who are glucocorticoid-dependent or intolerant. Inadequate and fluctuating symptom control contributes to sustained disease burden and impaired long-term quality of life.

Advances in the understanding of PMR pathophysiology have led to the development of targeted biologic therapies, offering the potential to address key unmet needs. Delivering the value of biologic treatment with appropriate urgency, while prioritizing rapid symptom relief and durable disease control, is increasingly critical to improving long-term outcomes and preserving quality of life for patients with PMR.