Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica

Abstract

Objective. To evaluate the impact of polymyalgia rheumatica (PMR) on clinical outcomes and quality of life (QOL); the relationship between laboratory measures and clinical outcomes, and changes in QOL; and agreement between rheumatologists in confirming the initial diagnosis. Methods. We conducted a prospective study of 129 participants in 8 hospitals in England who met a modified version of the Jones and Hazleman criteria and had not started steroid therapy. The main outcome measures were response to steroids after 3 weeks (minimum 50% improvement in proximal pain, morning stiffness <30 minutes, acute-phase response not elevated), relapses, QOL as measured by the Short Form 36 and Health Assessment Questionnaire, and diagnosis reassessment at 1 year. Results. At 3 weeks, 55% of participants failed to meet our definition of a complete response to steroid therapy. Both physical and mental QOL at presentation were substantially lower than general population norms and improved by 12.6 (95% confidence interval [95% CI] 10.8, 14.4) and 11.2 (95% CI 8.5, 13.8) points, respectively, at 1 year. Proximal pain and longer morning stiffness were significantly associated with lower physical QOL during followup, whereas erythrocyte sedimentation rate was most strongly associated with lower mental QOL during followup. There was moderate agreement between clinicians in confirming the PMR diagnosis (kappa coefficients 0.49 -0.65). Conclusion. PMR is a heterogeneous disease with a major impact on QOL. Ongoing monitoring should include disease activity based on symptoms, emergence of alternative diagnoses, and early referral of atypical and severe cases.

“I suddenly felt I’d aged”: A qualitative study of patient experiences of polymyalgia rheumatica (PMR)

“…It is characterised by pain and stiffness in the hips and shoulders, raised inflammatory markers and response to glucocorticosteroids, although atypical presentations can occur in up to 20% of those affected [3,4]. PMR has a major impact on quality of life [5] and treatment with corticosteroids is associated with a high rate of adverse effects [6]. Despite this, it remains an under-researched and poorly understood condition with the lack of primary care research particularly notable considering that the majority of PMR is diagnosed and managed in primary care [7].…”

Outcome Measures in Polymyalgia Rheumatica. A Systematic Review

“…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.…”

“…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 .…”

“…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)…”

Concise guidance: diagnosis and management of polymyalgia rheumatica

“…The list includes infection, neoplasia, inflammatory arthritis and connective tissue diseases. 4 Bhaskar Dasgupta, consultant in rheumatology, honorary professor, Essex University Southend University Hospital, Westcliff-on-Sea, Essex Concise Guidance to Good Practice Series editors: Lynne Turner-Stokes and Bernard Higgens *For membership of the guideline development group please see the full guideline 1 Concise guidance: diagnosis and management of polymyalgia rheumatica Bhaskar Dasgupta on behalf of the Polymyalgia Rheumatica Guideline Development Group*…”