Successful add-on clarithromycin treatment for polymyalgia rheumatica

Macrolide antibiotics (MACs) such as erythromycin and clarithromycin (CAM) provide not only anti-bacterial activity but also anti-inflammatory and immunomodulatory effects. Considering anti-inflammatory effects, several recent studies have reported the successful treatments of rheumatoid arthritis and polymyalgia rheumatica (PMR) treated using CAM. Herein, we also report another case of patient with PMR treated using CAM. A 72-year-old woman with PMR was treated using prednisolone (PSL) (20 mg/day). When muscle pain disappeared and C-reactive protein (CRP) decreased, the PSL dosage was gradually reduced without any sign of recurrence. When the PSL dosage was decreased to 5 mg/day, muscle pain returned, and CRP became positive. The PSL dosage was successfully increased to 8 mg/day. The PSL dosage was gradually decreased without any sign of recurrence. When the PSL dosage was again decreased to 5 mg/day, muscle pain returned, and CRP increased. As an alternative to increasing the PSL dosage, CAM was added. About four weeks after CAM treatment, the muscle pain disappeared, and CRP became negative. This case suggests that treatment using CAM may be effective in some cases of PMR.