Polymyalgia rheumatica and vertebral fractures: a 1-year pilot controlled study

Abstract

No data exist about the possibility that vertebral fracture in PMR patients could be independent of steroid therapy. For this reason, we aimed to investigate this topic by a case cohort study with a 1-year follow-up for each patient. We selected ten consecutive patients who experienced vertebral fractures (VF-group) during the Wrst month of 1-year follow-up period and without any other signiWcant associated condition. As a control group we studied ten control patients, without vertebral fractures and with a follow-up of 1 year, randomly selected among a larger group of patients aVected by polymyalgia rheumatica. The following data were analysed: eritrosedimention rate (ESR), visual analogical scale score (VAS), methyprednisolone daily dosage. Each patient had been monthly evaluated by the aforementioned clinical and laboratoristic parameters during the 1-year follow-up period. The VFgroup resulted with a higher and statistically signiWcant median corticosteroid 12-month total dosage [mean 3,480 mg (95%CI 2,805-3,030) vs. 2,760 mg (2,666.25-3,247.5)]. The VF-group had statistically signiWcant higher ESR and VAS AUC when compared to control group (median ESR AUC, 484.75 vs. 288.25; P = 0.0001; median VAS AUC, 70.75 vs. 43.5 P < 0.0001); ESR at the baseline (cut-oV >80 mm) showed a speciWcity of 90% (95%CI 56-100) and sensitivity of 70% (95%CI 35-93). VAS diVerence from Wrst to second month (cut-oV ·3) showed a speciWcity of 90% (95%CI 56-100) and sensitivity of 80% (95% CI 44-97). Our results point out that vertebral fracture might be predicted from commonly used laboratory (ESR) and clinical (VAS) Wndings.

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.…”

“…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)…”

“…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 .…”

“…Some observational studies were designed to assess specific adverse events related to GC, such as vertebral fractures 39,42 , bone mineral content 16,42 , cardiovascular and cerebrovascular events 32,42 . One study described mortality and its causes 29 .…”

“…ESR and CRP. ESR 12,13,14,15,16,17,18,19,21,22,24,25,26,27,28,30,31,33,34,35,36,37,38,39,40,43,44,45,46 and CRP 12,13,15,17,19,21,23,24,25,26,28,30,31,33,34,35,36,37,38,40,43,44,45,46 were used in the assessment of disease activity by ...…”