Clinical characteristics and prognostic factors for relapse in patients with polymyalgia rheumatica (PMR)

Abstract

Polymyalgia rheumatica (PMR) is a common inflammatory disease of the elderly in western countries, but the prevalence is apparently different between races and countries. Until now, an epidemiologic study of PMR is limited in Korea. We retrospectively evaluated the clinical data of 78 patients with PMR who were treated in 5 tertiary hospitals, and analyzed initial laboratory data, symptoms, therapeutic responses, and prognostic factors for relapse 1 year after treatments. Sixty percent of patients had pain in both shoulder and hip girdles with 10.6 weeks of duration, 75.9 ± 32.7 mm/h of erythrocyte sedimentation rate (ESR), and 6.2 ± 6.4 mg/dl of C-reactive protein. The rate of relapse and remission at 1 year was 38.4 and 2.5 %, respectively. The rate of overall relapse was 46.1 %, and the relapse occurred mostly in a year, especially between 6 and 12 months after diagnosis. There were more female in relapse group (88.9 %, p = 0.037), and cumulative steroid dose of 1 year was significantly higher in relapse group (5.5 ± 2.7 vs. 4.4 ± 2.5 g, p = 0.018). Independent risk factors for relapse were initial CRP ≥ 2.5 mg/dl (OR 6.296, p = 0.047) and the use of hydroxychloroquine (OR 6.798, p = 0.035). Initial dosage or tapering speed of steroid did not influence on prognosis. In Korean patients with PMR, baseline clinical characteristics and relapse rate were similar to previous studies, but our patients accompanied no giant cell arteritis and showed lower remission rate as well as delayed therapeutic response and later occurrence of relapse. More aggressive management would be needed according to the clinical status of patients.

2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative

“…Baseline factors that were associated with a higher relapse rate and/or prolonged therapy in PMR studies were: female sex (38,47), high erythrocyte sedimentation rate (ESR) (.40 mm/hour) (47)(48)(49)(50)(51)53) and peripheral inflammatory arthritis (54). A number of studies, however, failed to demonstrate association between these factors and relapse (48)(49)(50)(51)54,(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78). 4 Use the minimum effective dose out of a range of 12.5-25 mg prednisone equivalent daily: a high risk of relapse/prolonged therapy favors a higher dose, while a high risk of side effects favors a lower dose.…”

“…There was moderate to high quality of evidence (QoE) from studies indicating a benefit of MTX regarding remission (1 study) (27), relapse rate (1 study) (24), discontinuation of GC (1 study) (24) and cumulative GC doses (3 studies) (24,26,27). Evidence from one to four studies (1 related to remission, 4 to relapse, 1 to discontinuation of GC) indicating no benefit regarding these outcomes was of very low quality (25)(26)(27)51).…”

“…Hydroxychloroquine was investigated by a single very low QoE retrospective study reporting no benefit regarding relapse rate (51).…”

Epidemiology of Polymyalgia Rheumatica in Korea

“…However, only a small number of patients were included, and the studies were confined to specific tertiary health centers, which cannot represent the general population (5,6). Therefore, it is difficult to determine the actual status and characteristics of patients with PMR in Korea.…”

Clinical Features, Treatment and Monitoring in Patients With Polymyalgia Rheumatica

“…6 There are several studies about the epidemiology, clinical characteristics, and treatment options of patients with PMR. [7][8][9][10][11][12][13][14][15] To our knowledge, the epidemiological study of PMR within Turkish patients is limited in the literature. In this study, we aimed to evaluate the clinical symptoms and laboratory findings of Turkish patients with PMR.…”