Treatment of Polymyalgia Rheumatica

Hernández‐Rodríguez, José; Cid, María C.; López‐Soto, Alfons; Espígol‐Frigolé, Georgina; Bosch, Xavier

doi:10.1001/archinternmed.2009.352

Cited by 108 publications

(82 citation statements)

References 42 publications

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“…For example, we found one earlier SLR reporting similar conclusions regarding the value of MTX in PMR (58). In addition, two case series were recently published on the use of leflunomide (59,60) and a few case reports are available on tocilizumab (61)(62)(63).…”

Section: Discussionmentioning

confidence: 65%

2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative

Dejaco¹,

Singh

Perel

et al. 2015

Arthritis & Rheumatology

190

136

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Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR

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Section: Discussionmentioning

confidence: 65%

2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative

Dejaco¹,

Singh

Perel

et al. 2015

Arthritis & Rheumatology

190

136

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“…n INTRODUCTION G lucocorticoid therapy (GCs) is a frequently used treatment for rheumatic diseases, such as Rheumatoid Arthritis (RA), Polymyalgia Rheumatica (PMR), and Connective Tissue Diseases (CTDs) such as Systemic Lupus Erythematosus (SLE) (1)(2)(3). In RA the use of low-dose GCs has a welldefined effect on disease activity (4).…”

mentioning

confidence: 99%

“…GCs represent the gold standard treatment in PMR, reducing symptoms and suppressing inflammation within a few weeks. GCs act as inhibitors of the circadian release of pro-inflammatory cytokines (such as IL-6), reducing the duration of morning stiffness (2). Although a universal regimen of daily doses of GCs in PMR is not accepted, the EULAR/ACR 2015 recommendations for the management of PMR suggest an initial GCs administration dose within a range of 12.5-25 mg prednisone (PN), and then of 10 mg for 4-8 weeks before being tapered by 1 mg every 4-8 weeks (18).…”

mentioning

confidence: 99%

Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study

et al. 2017

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SUMMARYOsteoporosis and fractures are common and invalidating consequences of chronic glucorticoid (GC) treatment. Reliable information regarding the epidemiology of GC induced osteoporosis (GIOP) comes exclusively from the placebo group of randomized clinical trials while observational studies are generally lacking data on the real prevalence of vertebral fractures, GC dosage and primary diagnosis. The objective of this study was to evaluate the prevalence and incidence of osteoporotic fractures and to identify their major determinants (primary disease, GC dosage, bone mineral density, risk factors, specific treatment for GIOP) in a large cohort of consecutive patients aged >21 years, on chronic treatment with GC (≥5 mg prednisone -PN -equivalent) and attending rheumatology centers located all over Italy. Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) is a national multicenter cross-sectional and longitudinal observational study. 553 patients suffering from Rheumatoid Arthritis (RA), Polymyalgia Rheumatica (PMR) and Connective Tissue Diseases (CTDs) and in chronic treatment with GCs were enrolled. Osteoporotic BMD values (T score <-2.5) were observed in 28%, 38% and 35% of patients with CTDs, PMR or RA at the lumbar spine, and in 18%, 29% and 26% at the femoral neck, respectively. Before GC treatment, prevalent clinical fractures were reported by 12%, 37% and 17% of patients with CTDs, PMR, or RA, respectively. New clinical fragility fractures during GC treatment were reported by 12%, 10% and 23% of CTDs, PMR and RA patients, respectively. Vertebral fractures were the prevailing type of fragility fracture. More than 30% of patients had recurrence of fracture. An average of 80% of patients were in supplementation with calcium and/or vitamin D during treatment with GCs. Respectively, 64%, 80%, and 72% of the CTDs, PMR and RA patients were on pharmacological treatment for GIOP, almost exclusively with bisphosphonates. The GIOTTO study might provide relevant contributions to clinical practice, in particular by highlighting and quantifying in real life the prevalence of GIOP and relative fractures, the frequency of the main risk factors, and the currently sub-optimal prevention. Moreover, these results emphasize the importance of the underlying rheumatic disease on the risk of GIOP associated fractures.

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“…There is some evidence for this, 2 although not enough to persuade the authors of the British Society for Rheumatology Guidelines 3 to mention it. They, like the authors of a systematic review 4 published almost synchronously, suggested methotrexate instead, but as a secondary consideration only: steroids still rule.…”

Section: The Reviewmentioning

confidence: 99%

Aching decisions

Miller¹

2013

Br J Gen Pract

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Treatment of Polymyalgia Rheumatica

Cited by 108 publications

References 42 publications

2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative

2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative

Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study

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