Polymyalgia rheumatica and diverticular disease: just two distinct age-related disorders or more? Results from a case-control study

Abstract

In a previous report of two married cohabiting couples affected by polymyalgia rheumatica (PMR), we noticed that the wife of one couple and both members of the other couple suffered from symptomatic diverticular disease (DD), whose diagnosis was made before the onset of PMR. We investigated whether DD might be a risk factor for the development of PMR. We conducted a case-control study informed on a database containing the prospectively collected medical records of consecutive PMR patients. Among comorbidities, attention was focused on symptomatic DD, provided that the diagnosis had been made by colonoscopy and/or computed tomography scan. As controls, we identified one control per case at random among those matched by age and sex attending the ophthalmic and orthopedic outpatient clinics, as long as a PMR diagnosis had been excluded. A logistic regression model was used, following a multiplicative model, and results were presented as odds ratio (OR) and 95% confidence intervals (95% CI). The most frequent comorbidities in the two groups of patients (121 cases and 121 controls) were chronic coronary artery disease, atrial fibrillation, diabetes mellitus, hypertension, DD, hypercholesterolemia, osteoporosis, chronic obstructive pulmonary disease, gastroesophageal reflux disease, and cholelithiasis. The association between PMR and DD (OR = 4.06; 95% CI: 1.76-9.35) was by far stronger than that found comparing PMR with the other comorbidities. The chronic bowel inflammation induced by dysbiosis in patients with symptomatic DD could be a critical immunopathological mechanism supporting the development or exacerbation of PMR in susceptible individuals.

Comorbidities in polymyalgia rheumatica: a systematic review

“…The abstracts of 287 studies were assessed for eligibility, and 131 were excluded at this stage. The full texts of articles were reviewed and 41 were retained for data extraction [ 30 – 70 ]. This process, which followed PRISMA guidelines, including reasons for exclusion of studies [ 18 ], is illustrated in Fig.…”

“…Of the 41 included studies, 32 were cohort studies [ 30 – 61 ] and nine were case–control studies [ 62 – 70 ]. Eighteen of the cohort studies did not use a formal comparator group.…”

“…Bowness et al [ 31 ] found an increase in the risk of hypothyroid disease (RR 3.2 (95% confidence interval 1.71, 5.91)), but Juchet et al [ 33 ] did not. One recent case–control study found a significantly increased rate of diverticular disease prior to a diagnosis with PMR (OR 4.06 (95% CI 1.76–9.35)) [ 70 ].…”

Patient-Reported Outcomes Following Inpatient Multimodal Treatment Approach in Chronic Pain-Related Rheumatic Diseases

“… 41 These comorbidities may vary widely and include gastrointestinal problems, headaches, cardiovascular diseases, depression, or other diseases of the musculoskeletal system, and so on. 42 – 45 Many multimodal treatment programs described in the literature consist of successive therapeutic interventions. 46 However, there are structural requirements for providing a multidisciplinary team comprising various specialists, specialized therapists, and nurses.…”

Diverticular Disease: a Gut Microbiota Perspective

“…Recent studies also suggest that gastrointestinal diseases known to be associated with deep gut microbiota dysbiosis, such as ulcerative colitis and Helicobacter pylori infection may protect against the onset of diverticular disease [54,55]. Conversely, diverticular disease could represent a risk factor for autoimmune diseases, such as polymyalgia rheumatica, with gut-microbiota-induced immune dysfunction as a cross-road between the two conditions [56].…”