Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database

Abstract

The objective of this study was to evaluate glucocorticoid (GC) use in patients with polymyalgia rheumatica (PMR), giant cell arteritis (GCA) or both diseases (PMR + GCA) under rheumatological care. Data from patients with PMR (n = 1420), GCA (n = 177) or PMR + GCA (n = 261) from the National Database of the German Collaborative Arthritis Centers were analyzed regarding GCs and related comorbidities (osteoporosis, diabetes and cardiovascular disease), stratified by disease duration (DD). Longitudinal data were analyzed for all patients with a DD ≤ 2 years at database entry (n = 1397). Three-year data were available for 256 patients. Predictors of GC use ≥ 3 years were examined by logistic regression analyses. A total of 76% received GCs, and 19% (PMR) to 40% (GCA) received methotrexate. Median GC doses were 12.5 mg (PMR), 11.3 mg (GCA), and 20.0 mg/day (PMR + GCA) in a 0-6-month DD. Median GC doses ≤ 5 mg/day were reached at a 13-18-month DD in PMR patients and at a 19-24-month DD in GCA or PMR + GCA patients. In the multivariate analysis, baseline methotrexate (OR 2.03, [95% CI 1.27-3.24]), GCs > 10 mg/day (OR 1.65, [1.07-2.55]), higher disease activity (OR 1.12, [1.02-1.23]) (median 0.6 years DD), and female sex (OR 1.63 [1.09-2.43]) were predictive for GC therapy at ≥ 3 years. Of the examined comorbidities, only osteoporosis prevalence increased within 3 years. GC use for ≥ 3 years was reported in one-fourth of all the patients. A difficult-to-control disease activity within the first year was a good predictor of long-term GC need.

Long-term trends in rheumatology care

“…Alongside the successful changes in therapy, the NDB also reveals deficits in the care service. For many years inadequate implementation of the guidelines in everyday life has been observed [20], which in some patients is reflected in a delayed change of therapy, a high supply of glucocorticoids [21] and an inadequate supply of physical and complementary therapies [22] as well as rehabilitation [23].…”

“…A high prescription rate of glucocorticoids has been observed over the years, with dosages above 7.5 mg prednisolone equivalent decreasing and only a few patients being treated with high-dose glucocorticoids today [19]. However, almost 50% of long-term RA and polymyalgia rheumatica (PMR) patients remain on glucocorticoid therapy [19,21]. Today's recommendations to use glucocorticoids only as briefly as necessary have not yet established themselves among patients that have been ill for many years.…”

Prevalence of Giant Cell Arteritis Relapse in Patients Treated With Glucocorticoids: A Meta‐Analysis

“…The recommended treatment at diagnosis is high‐dose glucocorticoid (GC) therapy (0.7–1 mg/kg/day of prednisone), followed by progressive tapering when the disease is controlled and until GC withdrawal . The duration of treatment is still debated and a significant number of patients remain on long‐term low‐dose GCs to prevent relapse . Nevertheless, the risk of relapse remains high, reported to occur in >50% of patients during the course of the disease.…”

Neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio are associated with disease activity in polymyalgia rheumatica

“…4 Ultrasonography is used to identify bursitis or tenosynovitis in affected lesions, and magnetic resonance imaging and positron emission tomography scans with 18F-fluorodeoxyglucose have been investigated as imaging tools to assess inflammation around large joints in PMR. 13 Although PMR is generally considered a benign disorder with no adverse effects on long-term survival, most patients with PMR require long-term glucocorticoid therapy, which has several side effects, such as osteoporotic fractures and infection. [8][9][10][11] In addition, levels of several other proinflammatory cytokines, including IL-1α, IL-1β, IL-8, and monocyte chemoattractant protein-1, are elevated in symptomatic muscles.…”

“…12 Systemic glucocorticoids are the treatment of choice to relieve disease manifestations. 13 Although PMR is generally considered a benign disorder with no adverse effects on long-term survival, most patients with PMR require long-term glucocorticoid therapy, which has several side effects, such as osteoporotic fractures and infection.…”