In this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, host Amanda Mixon, PA-C, is joined by Claudia Rivera Salas, NP, to tackle one of the most challenging areas in rheumatology: managing patients with polymyalgia rheumatica (PMR) who do not respond well to glucocorticoids or struggle with steroid tapering. While steroids remain the cornerstone of PMR treatment, many patients relapse or develop serious steroid-related side effects, making it essential to consider steroid-sparing therapies and newer biologic options. Amanda and Claudia define refractory PMR, highlight key diagnostic considerations, and walk through real-world case discussions that illustrate when to escalate therapy. The conversation explores common pitfalls in management, the role of methotrexate and other DMARDs, and the growing impact of IL-6 inhibitors like sarilumab in helping patients achieve remission faster and with fewer toxicities. With practical guidance on shared decision-making, monitoring strategies, and treatment goals, this episode offers clinicians valuable insights to optimize care for patients with PMR while reducing long-term steroid dependence.