Retrospective analysis of the clinical course of patients treated for polymyalgia

Abstract

BackgroundPolymyalgia rheumatica is a chronic inflammatory rheumatic condition, for which the mainstay of treatment is corticosteroids. Here, we review the clinical course of treated patients initially presenting with polymyalgic symptoms.MethodsA retrospective audit was performed of patients who presented with a possible diagnosis of polymyalgia rheumatica. Biochemical markers and prednisone doses were assessed at the initial review, at one month, and 3, 6, and 12 months later.ResultsA cohort of 135 patients was identified, comprising 91 females and 44 males of mean age 70.7 years. All patients were treated with oral prednisone at an initial mean dose of 21.3 mg. Mean baseline C-reactive protein level and erythrocyte sedimentation rate were 41.6 mg/L and 48.6 mm/hour, respectively. Following initiation of therapy, there was a dramatic and sustained decrease in both inflammatory markers. A clinical response was observed in 96.2% of patients, but remission was achieved in only 18.2%. Of those initially diagnosed with polymyalgia rheumatica, 24.8% were subsequently diagnosed with a different rheumatic condition.ConclusionThe excellent response rate to corticosteroid therapy is well established in the literature, but in this research, remission rates were comparatively low during the 12-month study period. The current value of disease-modifying antirheumatic drugs and biologic therapy appears uncertain, and further trials to establish their precise role would be beneficial. A large portion of patients presenting with polymyalgia were eventually diagnosed to have another rheumatic disease, thus reflecting the broad differential diagnosis of polymyalgia symptoms. Polymyalgia symptoms can occur in patients with polymyalgia rheumatica and other rheumatic conditions. This group has a good response to prednisone therapy, although remission at 12 months appears to be uncommon. The gold standard of treatment remains corticosteroid therapy.

Predictors of glucocorticoid‐free remission in patients with polymyalgia rheumatica treated with prednisolone

“…whereas CRP is a more sensitive indicator of disease activity. 19,27 In the present study, baseline CRP, baseline ESR and the initial ESR response to PSL treatment were not associated with GC-free remission, while the initial CRP response to PSL treatment at 1 month was associated with GC-free remission.…”

Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica: a systematic literature review informing the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for the management of polymyalgia rheumatica

“…Four studies (n=480, low risk of bias (LoB) in three to six out of eight QUIPS+two categories) examined the prognostic relevance of age 20 39 47 52. In one study, older age was associated with lower healthcare resource use (n=364, LoB 6/8) 47…”

“…Acute phase reactants were examined by 16 studies (n=2067) 4 20 24 26 32 33 39 40 43 44 47 48 50 54 56 57. The parameter most commonly investigated was ESR, whereas C-reactive protein (six studies, n=722),4 24 32 33 39 57 interleukin 6 (one study, n=94)57 and plasma viscosity (one study, n=183)32 were less frequently tested.…”

“…The parameter most commonly investigated was ESR, whereas C-reactive protein (six studies, n=722),4 24 32 33 39 57 interleukin 6 (one study, n=94)57 and plasma viscosity (one study, n=183)32 were less frequently tested. For this report, we focused on ESR as results for other acute phase reactants were comparable.…”

Polymyalgia rheumatica

“…These patients were younger, more often male, needed higher initial glucocorticoid doses, and were less able to reduce and stop glucocorticoids during follow-up. 55 In another observational study, patients who needed higher initial glucocorticoid doses were likely to need glucocorticoids for longer, and were also more likely to develop giant cell arteritis at a later date. 48 There is no evidence that aggressively trying to reduce inflammatory markers improves prognosis in asymptomatic patients and it could mask a second disease.…”