The 2026 British Society for Rheumatology guideline for the treatment of polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic condition in older adults. Glucocorticoids (GCs) remain the cornerstone of treatment, but many people with PMR relapse during tapering and are exposed to prolonged GC therapy with associated toxicity. There is therefore a need for evidence-based strategies that optimize disease control while minimizing GC-related harm. This guideline was developed in line with the British Society for Rheumatology's Creating Clinical Guidelines Protocol (v6.0), using GRADE and AGREE II frameworks, and supersedes previously published 2009 BSR/BHPR PMR guidelines. Several key recommendations have been included in this guideline update. These include when to discuss or refer people with PMR to rheumatology; initiation of GCs and tapering with options for a faster GC taper; consideration of early methotrexate; IL-6 receptor antagonist use in people with PMR who are unable to taper GCs or have had an inadequate response; and bone protection in all people with PMR. Furthermore, the guideline emphazises the importance of ongoing patient education and counselling, monitoring for glucocorticoid toxicity and suggestions for when to refer people with PMR to secondary care. This guideline aims to support clinicians in delivering safe, effective and individualized care for people with PMR, while promoting judicious use of GCs and timely introduction of GC-sparing therapies where appropriate.