Polymyalgia rheumatica and steroid tapering: feasibility of a pharmacy technician-led service in primary care

Polymyalgia rheumatica (PMR) is a common inflammatory disorder among adults aged over 65 years and is primarily managed in primary care^​1,2​. It is characterised by rapid-onset and usually bilateral shoulder and pelvic girdle pain and stiffness ¹. Treatment with oral prednisolone, typically starting at 15mg once daily for three weeks, is very effective and brings rapid symptom relief, helping to confirm the diagnosis^​1–3​. 

PMR is a major cause of prolonged oral corticosteroid use^​1​; however, inconsistent and unstructured tapering practices often result in prolonged corticosteroid exposure, increasing associated steroid risks such as osteoporosis and metabolic complications^​4​.

Now part of the additional roles reimbursement service (ARRS) within primary care networks (PCNs), the primary care pharmacy workforce offers a scalable solution to help address this issue.

Intervention

A pharmacy technician–led PMR clinic was designed and piloted at Sabden and Whalley Medical Group in April 2024. Patients with confirmed PMR were referred to the pharmacy team by GPs. Initial patient contact occurred within four weeks of referral and all consultations took place by telephone. 

An in-house protocol was developed, aligned with British Society of Rheumatology (BSR) and National Institute for Health and Care Excellence guidelines^​1,2​. The pharmacy technician completed focused training sessions with a pharmacist and GP ahead of implementing the service. Training focused on prednisolone tapering schedules, fracture risk assessment, ensuring co-prescribing of gastro and bone health protective medications, screening questions to exclude the rare complication of giant cell arteritis (GCA) and the reinforcement of robust internal practice referral pathways in the event of complications.

All patients were provided with steroid alert cards and individually tailored prednisolone tapering charts. Patients were signposted to trusted sources of advice such as Versus Arthritis^​3​. Follow-up occurred every three months, or more regularly at patient request, with more flexible tapering when daily prednisolone doses dropped below 5mg. If symptoms recurred, patients were advised to revert to the last dose at which symptoms were well controlled, and to seek urgent GP review if GCA was suspected.

Results

Following a successful pilot, the service was embedded into routine pharmacy technician workflows. To date, 34 patients have been identified with 19 patients accepting prednisolone tapering charts provided by the pharmacy technician. Seven patients have discontinued prednisolone with three patients remaining on 1mg maintenance. Patients were contacted an average of six times during tapering (range 2–16). 

Outcome

The project has led to observable reductions in GP workload, with fewer requests for reviews. Patient knowledge and confidence to self-manage has improved, with clarity that they have a “check-in” appointment in situ with the pharmacy technician or can have one on request. Patients are having fewer extended PMR flares during steroid reductions as treatment has been personalised and individuals are now empowered to safely re-escalate doses when indicated. Patient feedback has been highly positive, describing improved understanding and confidence in their tapering plan.

Feedback from clinicians within the practice has also been overwhelmingly positive. This pathway is now embedded into routine workflows. Administration and other practice staff are now aware that for patient PMR queries, they can initially book the patient into the pharmacy technician’s designated PMR clinic, knowing that upwards referral to a GP will take place robustly if necessary.

Conclusion

Implementing a pharmacy technician–led PMR service in primary care is both feasible and well received. This model promotes safe, consistent, patient-centred corticosteroid tapering, optimises wrap-around care, optimises the skills of pharmacy technicians, and reduces GP workload. The model is scalable across PCNs and highlights opportunities for expanding pharmacy technician roles in chronic disease management.

Conor Corbett and Jodie Wilkinson,

Sabden and Whalley Medical Group, East Lancashire