Study of professional practices among rheumatologists in Burgundy: initial corticotherapy in polymyalgia rheumatica

Abstract

To study the initial dose of corticoids prescribed by rheumatologists in the Côte d'Or, a French department of Burgundy, in the treatment of polymyalgia rheumatica (PMR), the clinical and biological data of patients who consulted rheumatologists of the Côte d'Or between March 2006 and December 2008 for PMR were collected. The statistical analyses concerned the initially prescribed dose of prednisone: the median, mean, and standard deviation were calculated cumulatively and then for individual rheumatologists; the Mann-Whitney test was used to compare the mean initial doses prescribed with regard to (a) the main practice of the practitioner (private-practice or hospital rheumatologist), (b) the presence of clinical signs of severity, (c) severity of the inflammatory syndrome, and (d) the presence of clinical relapse with the decrease in corticoids. Ninety-nine patients were included (age = 72 ± 8.6 years, 59% women). The mean dose of prednisone prescribed was 27.4 ± 12.4 mg/day. Considerable inter- and intra-individual variabilities in the doses prescribed were noted. There was no significant difference concerning the dose prescribed according to the clinical severity or the type of practice. However, the dose was significantly higher (34.3 ± 14.7 vs. 25.5 ± 11.1 mg/day) in patients with a high sedimentation rate. Clinical relapse was not statistically linked to the initial dose of corticoids. This evaluation of professional practices among French rheumatologists shows that the initial dose of prednisone prescribed in PMR varies considerably and is higher than the dose currently recommended in the literature (15 mg/day).

Predictive factors associated with the therapeutic response in patients with polymyalgia rheumatica and remitting seronegative symmetrical synovitis with pitting edema syndrome

“…Conversely, over dosages and slow tapering speed may induce various adverse events such as infection and osteoporosis especially in elderly patients. On the other hand, some previous reports showed that clinical relapse is not statistically linked to the initial dosages of corticosteroids (2, 17,18). A previous report showed that the factor predicting a good response to the therapy of PMR is low body weight but not the disease severity (19).…”

“…The level of CRP before the treatment (initial CRP) was elevated in all cases (median ; 8.7 mg/dl, range ; 2.9 -14.7). All patients were treated with oral prednisolone (median ; 15 mg/day, range ; [10][11][12][13][14][15][16][17][18][19][20]. The median duration from onset to treatment start was 8 weeks (range ; 1-52 weeks).…”