Comorbidity in polymyalgia rheumatica

Chatzigeorgiou, Charikleia; McDermott, Michael

doi:10.4081/reumatismo.2018.1039

Cited by 12 publications

(14 citation statements)

References 48 publications

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“…Although hip pain is a more characteristic symptom of PMR, and inflammation has been observed in the synovium of proximal joints, lumbar BMD was also affected. However, vertebral fractures are the most common site of fracture in PMR [ 2 ]; therefore, BMD models in this area should still be considered.…”

Section: Discussionmentioning

confidence: 99%

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Retrospective Analysis of Factors Associated with Fracture in 714 Patients with Polymyalgia Rheumatica

Ark

Talash

Bukhari

2022

International Journal of Rheumatology

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Introduction. Polymyalgia rheumatica (PMR) is a disease of the elderly, associated with increased fracture risk due to glucocorticosteroid (GC) treatment with the additional possible influence of chronic inflammation. Risk factors for fracture in PMR have not been extensively studied. Hip structure analysis (HSA) is a way to measure bone morphology in the hip using dual X-ray absorptiometry (DEXA). It has been used as a predictor of fracture in epidemiological settings. HSA has not been studied in PMR before. Objectives. The object of this retrospective study was to determine if fracture risk in PMR was associated with densitometry data and to determine the influence, if any, of HSA on that association. Methods. 714 patients with PMR referred for a bone density estimate at a district general hospital from June 2004 to October 2010 were studied. Demographic data, GC use, alcohol consumption, smoking status, secondary osteoporosis, and fracture history were recorded. Bone mineral density (BMD), Z score, T score, body composition data, and HSA measurements were collected. These were geometric measurements taken from 2-dimensional DEXA images of the hip. Fracture was modelled as an outcome variable using logistic regression models, adjusted for age and sex. And the fit of the model was assessed by comparing the area under the curve (AUC). Results. 714 patients were studied, 532 (75%) were female, and mean age was 70.5 with SD of 8.8. 703 (98%) had been treated with GCs. Lumbar and femoral BMD models were significantly associated with fracture. Right femur OR 0.062 (0.014-0.285), left femur OR 0.098 (0.023-0.412), right femoral neck 0.078 (0.014-0.43), left femoral neck 0.104 (0.022-0.492), L1 0.192 (0.066-0.56), L2 OR 0.138 (0.053-0.358), L3 0.192 (0.079-0.463), and L4 0.243 (0.108-0.544). Cross-sectional area was the only HSA parameter that was associated with fracture OR 0.988 (0.980–0.997). Conclusion. L2 association models were strongest. Prospective studies are needed to elucidate whether these factors predict future fracture. GC data were binary, not reflecting dose and duration.

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Section: Discussionmentioning

confidence: 99%

“…It is associated with an increased risk of fracture in the UK population, with a hazard ratio of 1.63 and 95% confidence interval of 1.54–1.73 [ 1 ]. The most common site of fractures is the vertebrae, and they can happen despite antiresorptive therapy [ 2 ]. Fractures can lead to chronic pain and reduced quality of life.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of Factors Associated with Fracture in 714 Patients with Polymyalgia Rheumatica

Ark

Talash

Bukhari

2022

International Journal of Rheumatology

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“…RA has been shown to be a risk factor for osteoporosis independently from the treatment with GC ( 29 ), also in pre-menopausal women ( 30 ). On the other hand, despite the presence of few studies suggesting an increased risk for osteoporosis also in PMR, the overall body of evidence is still insufficient, and the independent contribution of the disease is not clear ( 31 ). In addition, local bone loss in PMR is not considered a typical finding.…”

Section: Discussionmentioning

confidence: 99%

Wnt Inhibitors and Bone Turnover Markers in Patients With Polymyalgia Rheumatica and Acute Effects of Glucocorticoid Treatment

et al. 2020

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Background: In polymyalgia rheumatica (PMR), data on bone turnover markers (BTM), on Wnt inhibitors (Dkk-1, sclerostin) and their changes induced by glucocorticoids (GC) are lacking. The aims of our study were to compare the baseline levels of Wnt inhibitors and BTM in PMR patients with healthy controls (HC) and to study their changes over the first 4 weeks of GC treatment. Materials and Methods: We enrolled 17 treatment-naïve patients affected by PMR and 17 age and sex-matched healthy controls (HC) from retired hospital personnel. PMR patients were administered methylprednisolone 16 mg daily for 4 weeks. Blood samples were taken at baseline and at week 4 for the PMR group, a single sample was taken for HC. N-propeptide of type I collagen (PINP), C-terminal telopeptide of type I collagen (CTX-I), sclerostin, Dkk-1, and C-reactive protein (CRP) were dosed. Results: At baseline, Dkk-1 was significantly higher in the PMR group as compared to HC (p = 0.002) while PINP, CTX-I and sclerostin levels were comparable between PMR patients and HC, After 4 weeks of GC treatment we found in the PMR group a decrease of PINP (mean ± SD percentage decrement as compared to baseline −40 ± 18.6%, p < 0.001), CTX-I (−23.5 ± 41.3%, p = 0.032), Dkk-1 (−22.4 ± 39.6, p = 0.033), and sclerostin (−32.49 ± 20.47, p < 0.001) as compared to baseline levels. Conclusions: In treatment-naïve PMR, systemic inflammation is associated with a dysregulation of the Wnt system (increased Dkk-1). Within the 1st month, treatment with GC showed noteworthy effects on bone resorption, formation, and on Wnt pathway modulators.

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“…The reported prevalence of depressive symptomatology in PMR varies from 2 to 29% [25]. The small sample size of published studies and the fact that they were conducted in secondary or tertiary care settings should be considered as a potential bias [19,26,27].…”

Section: Depression As Comorbiditymentioning

confidence: 99%

Depression and depressive symptoms in patients with polymyalgia rheumatica: discussion points, grey areas and unmet needs emerging from a systematic review of published literature

Manzo

Nizama-Vía²,

Milchert³

et al. 2020

Reumatologia

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Objectives: In 1979, Bird et al. proposed depression as a diagnostic criterion for polymyalgia rheumatica (PMR). More recently, the significance of depression in PMR patients has been re-proposed, , and some researchers have suggested that PMR may increase the risk of depression. The aim of our article is to evaluate the relationship between PMR and depression. Material and methods: Systematic literature searches were performed on 19 th and 20 th May 2020 based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The search was restricted to all studies and case reports with English abstract, published in any language, since 1979 (when depression was first proposed as a diagnostic criterion for PMR) describing the association of PMR with depression. Exclusion criteria were as follows: reviews, conference abstracts, comments, non-original articles; and articles discussing giant cell arteritis (GCA) and PMR when data and observations for the two conditions were not clearly subdivided. Results: The initial search yielded 812 papers, of which 115 duplicates were removed. A total of 697 articles had a first screening and 506 were excluded based on title and abstract reviews; 117 articles underwent full-length scrutiny, and 99 full-text articles were excluded because they did not meet the inclusion and exclusion criteria (reviews and comments = 58; articles with outcome of interest not reported = 34; low-quality articles = 7). At least, 18 articles were included in this review. Conclusions: The review did not find any studies that clarified the prevalence rates of depression in patients with PMR. Furthermore, the studies reviewed did not offer any clarity as to whether patients suffered from just depressive symptoms or clinical depression, and that accepted diagnostic criteria for depression had not been employed, indicating that a robust method for diagnosing depression had not been employed. Collaboration of different professionals should be improved through shared guidelines.

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Comorbidity in polymyalgia rheumatica

Cited by 12 publications

References 48 publications

Retrospective Analysis of Factors Associated with Fracture in 714 Patients with Polymyalgia Rheumatica

Retrospective Analysis of Factors Associated with Fracture in 714 Patients with Polymyalgia Rheumatica

Wnt Inhibitors and Bone Turnover Markers in Patients With Polymyalgia Rheumatica and Acute Effects of Glucocorticoid Treatment

Depression and depressive symptoms in patients with polymyalgia rheumatica: discussion points, grey areas and unmet needs emerging from a systematic review of published literature

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