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What vaccination is recommended to prevent pneumococcal infection in people 65 years and older?

Adults 65 years and older who have not previously received a pneumococcal conjugate vaccine (PCV) should receive one dose of PCV15 (Vaxneuvance) or PCV20 (Prevnar 20). If PCV15 is administered, it should be followed by a dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23) after one year; however, the interval can be shortened to eight weeks for people with immunocompromising conditions, cerebral spinal fluid leak, or cochlear implant. If PCV20 is used for the first pneumococcal immunization, a subsequent dose of PPSV23 is not indicated.

What treatment in addition to glucocorticoids may be considered in patients with polymyalgia rheumatica?

Early addition of methotrexate to glucocorticoid therapy should be considered in patients with polymyalgia rheumatica who are at high risk of relapse (e.g., those with high baseline erythrocyte sedimentation rate), glucocorticoid-related adverse effects, or comorbidities that are likely to be exacerbated by glucocorticoids (e.g., diabetes mellitus, osteoporosis).

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