(Dis)agreement of polymyalgia rheumatica relapse criteria, and prediction of relapse in a retrospective cohort

Abstract

Background To develop and assess a prediction model for polymyalgia rheumatica (PMR) relapse within the first year of glucocorticoid (GC) treatment. Methods A retrospective PMR cohort (clinical diagnosis) from a rheumatology department was used. All visits > 30 days after starting GC treatment and with > 2.5 mg/day oral prednisolone were used as potential relapse visits. Often used relapse criteria (1) rheumatologist judgement, (2) treatment intensification-based relapse) were assessed for agreement in this cohort. The proportion of patients with treatment-based relapse within 1 and 2 years of treatment and the relapse incidence rate were used to assess unadjusted associations with candidate predictors using logistic and Poisson regression respectively. After using a multiple imputation method, a multivariable model was developed and assessed to predict the occurrence (yes/no) of relapse within the first year of treatment. Results Data from 417 patients was used. Relapse occurred at 399 and 321 (of 2422) visits based on the rheumatologist judgement- and treatment-based criteria respectively, with low to moderate agreement between the two (87% (95% CI 0.86–0.88), with κ = 0.49 (95% CI 0.44–0.54)). Treatment-based relapse within the first two years was significantly associated with CRP, ESR, and pre-treatment symptom duration, and incidence rate with only CRP and ESR. A model to predict treatment intensification within the first year of treatment was developed using sex, medical history of cardiovascular disease and malignancies, pre-treatment symptom duration, ESR, and Hb, with an AUC of 0.60–0.65. Conclusion PMR relapse occurs frequently, although commonly used criteria only show moderate agreement, underlining the importance of a uniform definition and criteria of a PMR specific relapse. A model to predict treatment intensification was developed using practical predictors, although its performance was modest.

Subclinical giant cell arteritis increases the risk of relapse in polymyalgia rheumatica

“…However, these studies included relapses in the first 5 years of treatment 18–21. In a recent publication that included 450 patients, approximately 33% of them had at least one relapse within the first year of treatment, and 48% after 2 years 22. These figures adjusted by time are close to our rates of 31.3%.…”

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

“…It may also help in the prediction of CVD in those cases, but a prospective study on women concluded that CRP does not have a substantial effect in predicting incident RA [ 732 , 733 , 734 , 735 , 736 ]. Increased CRP values have been recorded for reactive arthritis, and also, old data reveal that CRP is elevated in polymyalgia rheumatica subjects and can respond to treatment, and a recent study found that increased CRP was associated with treatment-based relapses; specifically, mCRP has been reported in RA and polymyalgia rheumatica [ 737 , 738 ]. CRP can be notably elevated in relapsing polychondritis, but there can also exist cases with a minimal increase [ 739 ].…”

“…A meta-analysis revealed that basically, increased pretreatment CRP ≥ 10 mg/L has been significantly associated with worse outcomes either in early or advanced stages; therewithal, it might be a marker for metastatic gastric cancer [ 814 , 815 , 816 , 817 , 818 ]. Generally, in gastrointestinal cancer, increased CRP is associated with progressive disease, advanced stages of metastatic cancer, and poor survival [ 738 ]. Some case reports show notably elevated CRP values (>100 mg/L) during the diagnosis of extraintestinal Gastrointestinal Stromal Tumor (GIST), and a study indicated that CRP was higher while taking into account the location of the lower digestive tract, larger tumor size, and the higher mitotic index of the specific GIST [ 819 , 820 , 821 ].…”