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.

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In this video, Kyle George, PA-C, a rheumatology physician assistant with St. Luke’s Rheumatology in Idaho, reviews the key clinical takeaways from the 2015 ACR and EULAR treatment guidelines for polymyalgia rheumatica (PMR). PMR is a common inflammatory condition in older adults, marked by bilateral shoulder or hip girdle pain and stiffness. Kyle discusses the diagnostic criteria, the hallmark rapid response to low-dose glucocorticoids, and the importance of screening for concurrent giant cell arteritis (GCA). He breaks down recommended prednisone tapering strategies, the definition and management of disease flares, and the conditional use of methotrexate for patients with frequent relapses or steroid intolerance. The video also explores the emerging role of biologics, including the 2023 FDA approval of sarilumab, an IL-6 receptor inhibitor, for moderate to severe PMR. As treatment options evolve, understanding both the foundation of existing guidelines and new advances is critical to optimizing care. For more PMR-focused education, visit RhAPP.org.

In this video, clinical pharmacist and RhAPP faculty member Danielle Gatti Palumbo breaks down the mechanism of action of methotrexate, explaining how this folate antimetabolite works to inhibit DNA synthesis, reduce inflammation, and regulate immune response.

Methotrexate is a folate antimetabolite that plays a crucial role in inhibiting DNA synthesis, repair, and cellular replication, making it a widely used treatment for autoimmune diseases and certain cancers. Its primary mechanism involves binding to and inhibiting dihydrofolate reductase (DHFR), which prevents the formation of reduced folate, a key component in DNA and RNA synthesis. This inhibition is why folic acid supplementation is recommended for patients taking methotrexate. Additionally, methotrexate blocks thymidylate synthase (TS), further disrupting purine and pyrimidine synthesis, leading to decreased cell proliferation.

Beyond its effects on cellular replication, methotrexate exerts powerful anti-inflammatory properties by interfering with dendritic cell and T-cell communication, reducing pro-inflammatory cytokines, and increasing adenosine levels at sites of inflammation. These actions help suppress immune system overactivity, making methotrexate a cornerstone therapy in conditions like rheumatoid arthritis, psoriasis, and other autoimmune diseases. Furthermore, methotrexate promotes cell apoptosis, contributing to its efficacy in disease management.

For more insights into methotrexate, its uses, and best practices for patient care, visit the RhAPP website or explore additional educational content on the RhAPP ACE App.