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I am 70 years old and have been suffering from pain in my joints for months, especially in my knees. After having found the positivity of the rheumatoid factor, on the advice of the rheumatologist I first used cortisone and then methotrexate, with no benefits on the inflammatory indices Ves (erythrocyte sedimentation rate) and PCr (C-reactive protein), which remain high. Is it possible that the therapy is not adequate?

He answers Charles SelmiHead of Rheumatology and Clinical Immunology, Humanitas Institute, Milan (VAI AL FORUM)

The sudden onset of symmetrical pain in the joints and muscles of the upper and lower limbs after the age of 50, associated with an increase in ESR or CRP, may represent the onset of a polymyalgia rheumatica. This chronic inflammatory condition remains unclear to this day, but the complete answer is known steroid therapy; in some cases it can represent the onset of late-onset arthritis. It cannot be excluded that the increase in inflammatory indices derives from other mechanisms, such as a bacterial infection; on the other hand the presence of polymyalgia rheumatica can have other causes of pain, such as arthrosis is fibromyalgia, and the positivity of the rheumatoid factor present in about 5% of people over 60, even in the absence of rheumatological disease. In the case of polymyalgia rheumatica they are used decreasing doses of prednisone or other steroids and the evaluation of the response is based on clinical observation and symptoms, not necessarily proportional to the inflammatory indices. If it is not possible to reduce and suspend the steroid therapy, it is introduced methotrexate in order to save high doses of cortisone and also in this case the response will be evaluated from a clinical point of view and not laboratory tests.