Plasma Fibrinogen Along with Patient-reported Outcome Measures Enhances Management of Polymyalgia Rheumatica: A Prospective Study

McCarthy, Eoghan; MacMullan, Paul; Al-Mudhaffer, Shibeb; Madigan, Anne; Donnelly, Suzanne; McCarthy, Conor; Molloy, Eamonn; Kenny, Dermot; McCarthy, Geraldine

doi:10.3899/jrheum.131055

Cited by 10 publications

(21 citation statements)

References 33 publications

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“…The electronic search strategy yielded 868 articles, 43 of which were selected, on the basis of title and abstract, for further assessment/detailed review. Ultimately, 35 studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]42,43,44,45,46 met inclusion criteria for this systematic review (Figure 1). Agreement between the 2 reviewers was 96.6% and 100% for the first and second steps of article selection, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Three are nonrandomized interventional studies or ones without clear information about randomization 24,25,26 . Longitudinal observational studies represent more than one-half of selected articles (20 of 35) [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] . One of these observational studies 36 is a longterm followup of an already included RCT 20 .…”

Section: Resultsmentioning

confidence: 99%

“…Pain. Pain was used as an outcome in 17 studies 12,13,14,15,16,18,19,22,25,34,36,39,40,43,44,45,46 . A visual analog scale (VAS)…”

Section: Resultsmentioning

confidence: 99%

“…Morning stiffness. Stiffness, more commonly morning stiffness, was considered in almost all the included studies 13,14,15,16,18,19,20,21,22,24,25,26,27,28,30,33,34,35,36,37,38,40,43,44,45,46 . It was evaluated as an independent outcome in 11 studies 13,14,15,16,18,19,25,27,34,40,44 , and was included as a variable in composite disease activity scores or in the definition of relapse/recurrence/remission in an additional 15 studies 19,20,22,24,26,28,33,35,36,37,38,43,…”

Section: Journal Of Rheumatologymentioning

confidence: 99%

“…Patient and physician global assessment. Patient Global Assessment (PGA) of disease activity was measured in 9 studies 13,19,22,25,27,33,35,38,46 , always as a 0-10 cm VAS except in 2 studies 13,17 , where a 5-point ordinal scale was used.…”

Section: Journal Of Rheumatologymentioning

confidence: 99%

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Outcome Measures in Polymyalgia Rheumatica. A Systematic Review

et al. 2015

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Objective.To identify the instruments used to assess polymyalgia rheumatica (PMR) in published studies.Methods.A systematic literature review of clinical trials and longitudinal observational studies related to PMR, published from 1970 to 2014, was carried out. All outcome and assessment instruments were extracted and categorized according to core areas and domains, as defined by the OMERACT (Outcome Measures in Rheumatology) Filter 2.0.Results.Thirty-five articles (3221 patients) were included: 12 randomized controlled trials (RCT); 3 nonrandomized trials; and 20 observational studies. More than 20 domains were identified, measured by 29 different instruments. The most frequently used measures were pain, morning stiffness, patient global assessment and physician global assessment, erythrocyte sedimentation rate, and C-reactive protein. The definition of outcomes varied considerably between studies.Conclusion.The outcome measures and instruments used in PMR are numerous and diversely defined. The establishment of a core set of validated and standardized outcome measurements is needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Pain. Pain was used as an outcome in 17 studies 12,13,14,15,16,18,19,22,25,34,36,39,40,43,44,45,46 . A visual analog scale (VAS)…”

Section: Resultsmentioning

confidence: 99%

Section: Journal Of Rheumatologymentioning

confidence: 99%

Section: Journal Of Rheumatologymentioning

confidence: 99%

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Outcome Measures in Polymyalgia Rheumatica. A Systematic Review

et al. 2015

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Neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio are associated with disease activity in polymyalgia rheumatica

Jung

Lee

Suh

et al. 2019

Clinical Laboratory Analysis

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Background The neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and monocyte‐to‐lymphocyte ratio (MLR) are indicators of systemic inflammation and are useful as markers in systemic rheumatic diseases. In this study, we compared the NLR, PLR, and MLR among patients with polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA), and explored possible associations with clinical features, disease activity, and prognosis in patients with PMR. Methods The study enrolled 94 patients with PMR and 242 patients with RA who were initially diagnosed at the rheumatology clinic of a university‐based tertiary hospital. Symptoms, physical examination, and medical histories were collected with the results of laboratory tests. Results Neutrophil‐to‐lymphocyte ratio (4.5 ± 3.3 vs 2.8 ± 1.8), PLR (222.7 ± 115.5 vs 159.7 ± 78.1), and MLR (0.4 ± 0.3 vs 0.3 ± 0.2) were higher in patients with PMR compared with patients with RA (all P < .001). NLR, PLR, and MLR were correlated with specific laboratory values, including CRP and albumin, in patients with PMR. After disease activity resolved, NLR (2.95 ± 2.32, P < .001), PLR (137.5 ± 82.3, P < .001), and MLR (0.26 ± 0.16, P < .001) decreased significantly. By comparing patients according to the disease course, swollen joint counts were higher in the chronic course group compared with the remission group (P = .03), while the NLR, PLR, and MLR were similar. Conclusions Neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio, and monocyte‐to‐lymphocyte ratio levels were associated with disease activity and specific clinical features, although they could not predict prognosis in patients with PMR.

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Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

et al. 2020

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Giant cell arteritis (GCA) is the most common type of primary vasculitis in Western countries 1,2. Polymyalgia rheumatica (PMR) is the second most common inflammatory rheumatic disease of the elderly after rheumatoid arthritis (RA) 3. The two diseases are interrelated: 40-60% of patients with GCA have symptoms of PMR 3 , and histological features consistent with GCA have been found in 16-21% of temporal artery biopsy samples from patients with PMR 3. Most of these patients with PMR, however, presented with additional features of GCA, whereas the prevalence of positive histology in unselected patients with PMR is unknown. Both GCA and PMR are heterogeneous diseases. Although systemic manifestations (such as fever, malaise and weight loss) are common in both diseases, they are not present in all patients 4-6. Up to 1 in 5 patients with GCA with ocular involvement can present without systemic manifestations of the disease 7. GCA is the most common form of large-vessel vasculitis (LVV) and has a broad spectrum of disease manifestations, which are frequently overlapping. In the majority of cases, cranial and extracranial large arteries are involved to varying degrees, leading to different clinical phenotypes 8,9. Isolated cranial or extracranial GCA, which are at either end of this continuum, are relatively uncommon 10. Predominant cranial GCA is characterized by headache, jaw claudication and visual manifestations (representing the prototypical clinical picture of temporal arteritis). By contrast, predominant large-vessel GCA is characterized by more pronounced systemic manifestations, PMR, vascular bruits, limb claudication and imaging signs of inflammation in the aorta and its major branches 10. In some of these patients, vascular stenoses or aneurysms in association with other GCA features are the presenting clinical manifestations 9,11. PMR is characterized by pain and stiffness in the shoulder and pelvic girdles, which can have an abrupt or a subtle onset 3. Up to 20% of patients with PMR can present with a normal erythrocyte sedimentation rate (ESR) 12 , although the presence of both normal ESR and C-reactive protein (CRP) levels is rare 13-15. Glucocorticoids are the cornerstone of treatment for GCA and PMR. They are effective, but glucocorticoidrelated adverse effects occur in up to 85% of patients with GCA and 65% of patients with PMR, respectively 16-22. The IL-6 receptor inhibitor tocilizumab has become available as a glucocorticoid-sparing strategy in patients with GCA 23,24 , an approach that is also being evaluated for PMR 25,26. Management of both GCA and PMR is hampered by the lack of universally accepted definitions of remission and other disease states (such as low disease activity or vessel damage without active disease). Many questions about monitoring and long-term management are still unanswered (Box 1).

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Plasma Fibrinogen Along with Patient-reported Outcome Measures Enhances Management of Polymyalgia Rheumatica: A Prospective Study

Cited by 10 publications

References 33 publications

Outcome Measures in Polymyalgia Rheumatica. A Systematic Review

Outcome Measures in Polymyalgia Rheumatica. A Systematic Review

Neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio are associated with disease activity in polymyalgia rheumatica

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

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