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De Miguel E, Karalilova R, Macchioni P, Ponte C, Conticini E, Cowley S, Tomelleri A, Monti S, Monjo I, Batalov Z, Klinowski G, Falsetti P, Kane DJ, Campochiaro C, Hočevar A. Subclinical giant cell arteritis increases the risk of relapse in polymyalgia rheumatica. Ann Rheum Dis 2024; 83:335-341. [PMID: 37932008 DOI: 10.1136/ard-2023-224768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE The aim of the present study was to determine the clinical significance of subclinical giant cell arteritis (GCA) in polymyalgia rheumatica (PMR) and ascertain its optimal treatment approach. METHODS Patients with PMR who fulfilled the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology Provisional Classification Criteria for PMR, did not have GCA symptoms and were routinely followed up for 2 years and were stratified into two groups, according to their ultrasound results: isolated PMR and PMR with subclinical GCA. The outcomes (relapses, glucocorticoid use and disease-modifying antirheumatic drug treatments) between groups were compared. RESULTS We included 150 patients with PMR (50 with subclinical GCA) with a median (IQR) follow-up of 22 (20-24) months. Overall, 47 patients (31.3 %) had a relapse, 31 (62%) in the subclinical GCA group and 16 (16%) in the isolated PMR group (p<0.001). Among patients with subclinical GCA, no differences were found in the mean (SD) prednisone starting dosage between relapsed and non-relapsed patients (32.4±15.6 vs 35.5±12.1 mg, respectively, p=0.722). Patients with subclinical GCA who relapsed had a faster prednisone dose tapering in the first 3 months compared with the non-relapsed patients, with a mean dose at the third month of 10.0±5.2 versus 15.2±7.9 mg daily (p<0.001). No differences were found between relapsing and non-relapsed patients with subclinical GCA regarding age, sex, C reactive protein and erythrocyte sedimentation rate. CONCLUSIONS Patients with PMR and subclinical GCA had a significantly higher number of relapses during a 2-year follow-up than patients with isolated PMR. Lower starting doses and rapid glucocorticoid tapering in the first 3 months emerged as risk factors for relapse.
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Affiliation(s)
| | | | | | - Cristina Ponte
- Rheumatology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | | | - Sharon Cowley
- Tallaght University Hospital & Trinity College Dublin, Dublin, Ireland
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Sara Monti
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Irene Monjo
- Rheumatology, La Paz University Hospital, Madrid, Spain
| | - Zguro Batalov
- Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria
- Rheumatology, University Hospital Kaspela, Plovdiv, Bulgaria
| | - Giulia Klinowski
- Rheumatology Department, Ospedale S Maria Nuova, Reggio Emilia, Italy
| | - Paolo Falsetti
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - David J Kane
- Rheumatology, Adelaide and Meath Hospital, Dublin, Ireland
| | - Corrado Campochiaro
- Università Vita-Salute San Raffaele, School of Medicine; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Alojzija Hočevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Vinicki JP, Gut O, Maliandi MDR, Velasco Zamora JL, Linarez M, Cusa MA, Got J, Spinetto MA, Estevez AJ, Brigante A, Curti AC, Costi AC, Cavallasca J. Risk Factors for Relapse and/or Prolonged Glucocorticoid Therapy in Polymyalgia Rheumatica: Multicenter Study in 185 Patients. J Clin Rheumatol 2024; 30:e34-e38. [PMID: 37185203 DOI: 10.1097/rhu.0000000000001969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND In polymyalgia rheumatica (PMR) relapses and long-term GC dependency are common. We assessed risk factors for higher relapse rate and/or prolonged glucocorticoid therapy in PMR patients. METHODS A multicenter and observational study (chart review) of PMR patients seen between 2006 and 2021 who had at least a 3-month follow-up period after starting GCs was performed. Results were expressed as median and interquartile range 25th-75th or mean ± standard deviation for numerical variables and percentage for categorical ones. Relapse versus nonrelapse groups were compared using Cox proportional analysis. Hazards ratios (HRs) with 95% confidence intervals (CIs) are reported. In all cases, a p value <0.05 was considered to indicate statistical significance. RESULTS We included 185 patients (69.1% female). The median follow-up time was 17.1 months (interquartile range, 6.8-34.7). Incidence of relapses was 1.2 per 100 persons/month. In univariate analysis, PMR patients with a previous history of dyslipidemia had a lower risk of relapse (HR, 0.55; 95% CI, 0.33-0.94; p = 0.03); high-dose GC (HR, 2.35; 95% CI, 1.42-3.87; p = 0.001) and faster GC dose reduction had higher risk of relapse (HR, 3.04; 95% CI, 1.77-5.21; p = 0.001). In multivariate analysis, a previous history of dyslipidemia had a lower risk of relapse (HR, 0.54; 95% CI, 0.32-0.92; p = 0.023), and high dose of GC (HR, 2.46; 95% CI, 1.49-4.08; p = 0.001) remained the only risk factors for relapse. CONCLUSIONS Lower doses of corticosteroids and a slow rate of reduction are critical to avoid relapse in PMR. Risk factors for higher relapse rate rely on therapy more than clinical characteristics of the patients at the time of diagnosis of PMR.
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Affiliation(s)
| | | | | | | | | | | | - Julio Got
- Unidad de Reumatología, Instituto Médico Humanitas, Chaco
| | | | | | | | | | | | - Javier Cavallasca
- Sección Reumatología, Hospital José Bernardo Iturraspe, Santa Fe, Argentina
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Tanaka Y, Tanaka S, Takahashi T, Kato N. Clinical features of polymyalgia rheumatica patients in Japan: Analysis of real-world data from 2015 to 2020. Mod Rheumatol 2023; 34:201-207. [PMID: 36881671 DOI: 10.1093/mr/road026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/19/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To assess clinical features in patients with polymyalgia rheumatica (PMR) in Japan by the International Classification of Disease (ICD)-10 code assignment. METHODS Demographics, treatment patterns, and concomitant diseases (identified using ICD-10 code only) in patients who were assigned the PMR ICD-10 code M35.3 at least once between 1 January 2015 and 31 December 2020 were aggregated from a nationwide medical information database owned by the Health, Clinic, and Education Information Evaluation Institute. RESULTS The cumulative number of patients with PMR was 6325 (mean [standard deviation] age, 74.3 [11.4] years; male:female, 1:1.3). Most patients were >50 years (96.5%) with >33% between 70 and 79 years. Glucocorticoids were prescribed in ∼54% of patients within 30 days of PMR code assignment. All other drug types were prescribed in <5% of patients. Hypertension, diabetes mellitus, rheumatoid arthritis, and osteoporosis were noted in >25% and giant cell arteritis in 1% of patients. During the study period, 4075 patients were newly assigned the PMR code and 62% were prescribed glucocorticoids within 30 days. CONCLUSIONS This is the first retrospective real-world data analysis describing the clinical features of PMR in a large patient population from Japan. Further studies of prevalence, incidence, and clinical features are warranted in patients with PMR.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shinichi Tanaka
- Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | | | - Naoto Kato
- Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan
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Paltta J, Suuronen S, Pirilä L, Palomäki A. Differential diagnostics of polymyalgia rheumatica in a university hospital in Finland. Scand J Rheumatol 2023; 52:689-695. [PMID: 37335188 DOI: 10.1080/03009742.2023.2215044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Diagnosing polymyalgia rheumatica (PMR) can be difficult as many conditions present with similar symptoms and findings. This study aimed to analyse how often the diagnosis of PMR changes during follow-up in a university hospital setting and to determine the most common clinical conditions initially misdiagnosed as PMR. METHOD All patients with a new primary diagnosis of PMR on at least one visit during the years 2016-2019 were identified from the hospital discharge register of Turku University Hospital, Finland. A diagnosis of PMR was confirmed if the patient met at least one of the five classification criteria, complete clinical follow-up (median 34 months) was compatible with PMR, and no other diagnosis better explained their condition. RESULTS Of the patients initially diagnosed with PMR, 65.5% were considered to have PMR after further evaluation and clinical follow-up. The most common conditions initially diagnosed as PMR were inflammatory arthritides (34.9%), degenerative or stress-related musculoskeletal disorders (13.2%), infection (9.3%), malignancy (9.3%), giant cell vasculitis (6.2%) and other vasculitis (6.2%), and a wide range of other less common diseases. The diagnosis of PMR remained in 81.3% of patients who fulfilled the 2012 American College of Rheumatology/European League Against Rheumatism PMR classification criteria and in 45.5% of patients who did not. CONCLUSIONS Diagnosing PMR is challenging, even in a university hospital. One-third of the initial diagnoses of PMR changed during further evaluation and follow-up. There is a substantial risk of misdiagnosis, especially in patients with atypical presentation, and the differential diagnoses of PMR must be considered carefully.
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Affiliation(s)
- J Paltta
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - S Suuronen
- Department of Medicine, University of Turku, Turku, Finland
| | - L Pirilä
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - A Palomäki
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
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Spiera RF, Unizony S, Warrington KJ, Sloane J, Giannelou A, Nivens MC, Akinlade B, Wong W, Bhore R, Lin Y, Buttgereit F, Devauchelle-Pensec V, Rubbert-Roth A, Yancopoulos GD, Marrache F, Patel N, Dasgupta B. Sarilumab for Relapse of Polymyalgia Rheumatica during Glucocorticoid Taper. N Engl J Med 2023; 389:1263-1272. [PMID: 37792612 DOI: 10.1056/nejmoa2303452] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND More than half of patients with polymyalgia rheumatica have a relapse during tapering of glucocorticoid therapy. Previous studies have suggested that interleukin-6 blockade may be clinically useful in the treatment of polymyalgia rheumatica. Sarilumab, a human monoclonal antibody, binds interleukin-6 receptor α and efficiently blocks the interleukin-6 pathway. METHODS In this phase 3 trial, we randomly assigned patients in a 1:1 ratio to receive 52 weeks of a twice-monthly subcutaneous injection of either sarilumab (at a dose of 200 mg) plus a 14-week prednisone taper or placebo plus a 52-week prednisone taper. The primary outcome at 52 weeks was sustained remission, which was defined as the resolution of signs and symptoms of polymyalgia rheumatica by week 12 and sustained normalization of the C-reactive protein level, absence of disease flare, and adherence to the prednisone taper from weeks 12 through 52. RESULTS A total of 118 patients underwent randomization (60 to receive sarilumab and 58 to receive placebo). At week 52, sustained remission occurred in 28% (17 of 60 patients) in the sarilumab group and in 10% (6 of 58 patients) in the placebo group (difference, 18 percentage points; 95% confidence interval, 4 to 32; P = 0.02). The median cumulative glucocorticoid dose at 52 weeks was significantly lower in the sarilumab group than in the placebo group (777 mg vs. 2044 mg; P<0.001). The most common adverse events with sarilumab as compared with placebo were neutropenia (15% vs. 0%), arthralgia (15% vs. 5%), and diarrhea (12% vs. 2%). More treatment-related discontinuations were observed in the sarilumab group than in the placebo group (12% vs. 7%). CONCLUSIONS Sarilumab showed significant efficacy in achieving sustained remission and reducing the cumulative glucocorticoid dose in patients with a relapse of polymyalgia rheumatica during glucocorticoid tapering. (Funded by Sanofi and Regeneron Pharmaceuticals; SAPHYR ClinicalTrials.gov number, NCT03600818.).
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Affiliation(s)
- Robert F Spiera
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Sebastian Unizony
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Kenneth J Warrington
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Jennifer Sloane
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Angeliki Giannelou
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Michael C Nivens
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Bolanle Akinlade
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Wanling Wong
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Rafia Bhore
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Yong Lin
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Frank Buttgereit
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Valerie Devauchelle-Pensec
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Andrea Rubbert-Roth
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - George D Yancopoulos
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Frederic Marrache
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Naimish Patel
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Bhaskar Dasgupta
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
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6
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Conticini E, Falsetti P, d'Alessandro M, Al Khayyat SG, Grazzini S, Baldi C, Acciai C, Gentileschi S, D'Alessandro R, Bellisai F, Biasi G, Barreca C, Bargagli E, Cantarini L, Frediani B. Clinical, laboratory and ultrasonographic findings at baseline predict long-term outcome of polymyalgia rheumatica: a multicentric retrospective study : Polymyalgia rheumatica predicted by ultrasonographic findings polymyalgia rheumatica outcome predicted early by ultrasound. Intern Emerg Med 2023; 18:1929-1939. [PMID: 37498353 PMCID: PMC10543828 DOI: 10.1007/s11739-023-03373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023]
Abstract
To assess the rate of PMR who, during the follow-up, undergo a diagnostic shift as well as to assess which clinical, laboratory and US findings are associated to a diagnostic shift and predict the long-term evolution of PMR. All PMR followed-up for at least 12 months were included. According to the US procedures performed at diagnosis, patients were subdivided into four subgroups. Clinical data from follow-up visits at 12, 24, 48 and 60 months, including a diagnostic shift, the number of relapses and immunosuppressive and steroid treatment, were recorded. A total of 201 patients were included. During the follow-up, up to 60% had a change in diagnosis. Bilateral LHBT was associated with persistence in PMR diagnosis, whereas GH synovitis and RF positivity to a diagnostic shift. Patients undergoing diagnostic shift had a higher frequency of GH synovitis, shoulder PD, higher CRP, WBC, PLT and Hb and longer time to achieve remission, while those maintaining diagnosis had bilateral exudative LHBT and SA-SD bursitis, higher ESR, lower Hb and shorter time to remission. Cluster analysis identified a subgroup of older patients, with lower CRP, WBC, PLT and Hb, lower PD signal or peripheral synovitis who had a higher persistence in PMR diagnosis, suffered from more flares and took more GCs. Most PMR have their diagnosis changed during follow-up. The early use of the US is associated with a lower dosage of GCs. Patients with a definite subset of clinical, laboratory and US findings seem to be more prone to maintain the diagnosis of PMR.
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Affiliation(s)
- Edoardo Conticini
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Paolo Falsetti
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci, 16, 53100, Siena, Italy.
| | - Suhel Gabriele Al Khayyat
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Silvia Grazzini
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Caterina Baldi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Caterina Acciai
- Neurorehabilitation Unit, San Donato Hospital, 52100, Arezzo, Italy
| | - Stefano Gentileschi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Roberto D'Alessandro
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Francesca Bellisai
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Giovanni Biasi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Cristiana Barreca
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Luca Cantarini
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
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7
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Moreel L, Doumen M, Betrains A, Blockmans D, Verschueren P, Vanderschueren S. The future of polymyalgia rheumatica research: What can we learn from rheumatoid arthritis? Joint Bone Spine 2023; 90:105529. [PMID: 36690063 DOI: 10.1016/j.jbspin.2023.105529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Lien Moreel
- Department of General Internal Medicine, University Hospitals Leuven, 49, Herestraat, 3000 Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
| | - Michaël Doumen
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Albrecht Betrains
- Department of General Internal Medicine, University Hospitals Leuven, 49, Herestraat, 3000 Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Daniel Blockmans
- Department of General Internal Medicine, University Hospitals Leuven, 49, Herestraat, 3000 Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), Utrecht, The Netherlands
| | - Patrick Verschueren
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Steven Vanderschueren
- Department of General Internal Medicine, University Hospitals Leuven, 49, Herestraat, 3000 Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), Utrecht, The Netherlands
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8
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Tomelleri A, van der Geest KSM, Khurshid MA, Sebastian A, Coath F, Robbins D, Pierscionek B, Dejaco C, Matteson E, van Sleen Y, Dasgupta B. Disease stratification in GCA and PMR: state of the art and future perspectives. Nat Rev Rheumatol 2023:10.1038/s41584-023-00976-8. [PMID: 37308659 DOI: 10.1038/s41584-023-00976-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/14/2023]
Abstract
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are closely related conditions characterized by systemic inflammation, a predominant IL-6 signature, an excellent response to glucocorticoids, a tendency to a chronic and relapsing course, and older age of the affected population. This Review highlights the emerging view that these diseases should be approached as linked conditions, unified under the term GCA-PMR spectrum disease (GPSD). In addition, GCA and PMR should be seen as non-monolithic conditions, with different risks of developing acute ischaemic complications and chronic vascular and tissue damage, different responses to available therapies and disparate relapse rates. A comprehensive stratification strategy for GPSD, guided by clinical findings, imaging and laboratory data, facilitates appropriate therapy and cost-effective use of health-economic resources. Patients presenting with predominant cranial symptoms and vascular involvement, who usually have a borderline elevation of inflammatory markers, are at an increased risk of sight loss in early disease but have fewer relapses in the long term, whereas the opposite is observed in patients with predominant large-vessel vasculitis. How the involvement of peripheral joint structures affects disease outcomes remains uncertain and understudied. In the future, all cases of new-onset GPSD should undergo early disease stratification, with their management adapted accordingly.
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Affiliation(s)
- Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Alwin Sebastian
- Department of Rheumatology, University Hospital Limerick, Limerick, Ireland
| | - Fiona Coath
- Rheumatology Department, Mid and South Essex University Hospitals NHS Foundation Trust, Southend University Hospital, Westcliff-on-sea, UK
| | - Daniel Robbins
- Medical Technology Research Centre, School of Allied Health, Anglia Ruskin University, Chelmsford, UK
| | - Barbara Pierscionek
- Faculty of Health Education Medicine and Social Care, Medical Technology Research Centre, Anglia Ruskin University, Chelmsford Campus, Chelmsford, UK
| | - Christian Dejaco
- Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsus Medical University, Bruneck, Italy
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Eric Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Yannick van Sleen
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bhaskar Dasgupta
- Rheumatology Department, Mid and South Essex University Hospitals NHS Foundation Trust, Southend University Hospital, Westcliff-on-sea, UK.
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Reisch M, Dejaco C. [Methods for assessment of disease activity of polymyalgia rheumatica]. Z Rheumatol 2023:10.1007/s00393-023-01358-x. [PMID: 37184675 DOI: 10.1007/s00393-023-01358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 05/16/2023]
Abstract
Polymyalgia rheumatica (PMR) is the second most frequent inflammatory rheumatic disease in old age. Remission and recurrence are frequently used as endpoints in clinical trials; however, there is as yet no international consensus on the definition of these states, which limits the comparability of published studies. The PMR activity score (PMR-AS) is the only composite score specifically developed for PMR, which together with remission is used to define low, middle and high disease activity. In recent studies the PMR-AS was often used and low disease activity was established as endpoint. The most important limitation of the PMR-AS is the potential influence of the individual variables by comorbidities. The value of C‑reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) are of restricted value in studies using drugs that influence the interleukin 6 (IL-6) axis. In these cases, calprotectin and osteopontin are promising alternative biomarkers, as they have already been shown to reflect disease activity independently of CRP in rheumatoid arthritis. Furthermore, imaging modalities including sonography, magnetic resonance imaging and fluorodeoxyglucose (FDG) positron emission tomography could also be helpful in monitoring disease activity; however, these techniques must first be validated in further studies. The PMR impact scale (PMR-IS) is a composite score to assess the impact of PMR on the patients; however, it has not yet been used in clinical studies. The development of additional patient reported outcomes (PRO) for PMR and the definition of standardized criteria for documentation of remission and recurrence are important questions in the future research agenda for PMR.
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Affiliation(s)
- Myriam Reisch
- Abteilung für Rheumatologie und Immunologie, Medizinische Universität Graz, Graz, Österreich
| | - Christian Dejaco
- Abteilung für Rheumatologie und Immunologie, Medizinische Universität Graz, Graz, Österreich.
- Rheumatologie, Krankenhaus Bruneck, Südtiroler Sanitätsbetrieb: Azienda Sanitaria dell'Alto Adige, Spitalstr. 11, 39031, Bruneck (BZ), Italien.
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10
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Bolhuis TE, Marsman DE, den Broeder AA, den Broeder N, van der Maas A. 1-year results of treatment with rituximab in polymyalgia rheumatica: an extension study of a randomised double-blind placebo-controlled trial. THE LANCET. RHEUMATOLOGY 2023; 5:e208-e214. [PMID: 38251523 DOI: 10.1016/s2665-9913(23)00032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Rituximab was effective for patients with polymyalgia rheumatica in the 21-week BRIDGE-PMR randomised controlled trial. Here, we aimed to assess rates of glucocorticoid-free remission up to 1 year after infusion in an extension of this trial. METHODS BRIDGE-PMR was a randomised controlled proof-of-concept trial that enrolled participants with polymyalgia rheumatica according to 2012 European League Against Rheumatism-American College of Rheumatology classification criteria at the Sint Maartenskliniek, Nijmegen, Netherlands. Patients were randomly allocated in a 1:1 ratio to receive one intravenous dose of 1000 mg rituximab or placebo, with identical pre-medication and accelerated glucocorticoid tapering over 17 weeks. After the 21-week study, patients were followed in a double-blind extension until 1 year after infusion during which standard-of-care treatment was provided. The primary outcome after 52 weeks was between-group difference in glucocorticoid-free remission (ie, polymyalgia rheumatica activity score [PMR-AS] <10), assessed in all randomly allocated participants, with data imputed using a predictive mean matching model (provided data were missing at random). A sensitivity analysis restricted to patients with complete data (complete case analysis) was also done. This trial is registered with EudraCT (2018-002641-11) and the Dutch trial database (NL7414). FINDINGS Between Dec 18, 2019 and June 8, 2021, 47 patients enrolled in the BRIDGE-PMR were followed up in this extension study (23 [11 women and 12 men] allocated rituximab and 24 [13 women and 11 men] allocated placebo), of who 38 had recently diagnosed polymyalgia rheumatica and nine had relapsing polymyalgia rheumatica. Mean (SD) age was 64 (10) years in the rituximab group and 66 (9) years in the placebo group. All participants were White. Missing data were imputed for six participants (four rituximab, two placebo); because the data were probably missing at random, a complete case analysis was added as sensitivity analyses. In the imputed analysis, the between-group absolute difference reached statistical significance (12 [52%] of 23 in the rituximab group in glucocorticoid-free remission vs five [21%] of 24 participants in the placebo group; absolute difference 31% [95% CI 5 to 57], RR 2·5 [1·0 to 6·0]; p=0·04). In the complete case analysis, nine (47%) of 19 patients in the rituximab group were in glucocorticoid-free remission 1 year after infusion compared with five (23%) of 22 in the placebo group (absolute difference 25% [95% CI -4 to 53], relative risk (RR) 2·1 [95% CI 0·8 to 5·2]; p=0·12). Eight (33%) patients in the placebo group and six (26%) in the rituximab group had adverse events. INTERPRETATION After a single dose of rituximab (1000 mg), the proportion of patients with polymyalgia rheumatica in glucocorticoid-free remission remained stable at 1 year after infusion, and a glucocorticoid sparing effect was evident. A larger trial including possibility for retreatment is warranted to confirm these results. FUNDING Sint Maartenskliniek.
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Affiliation(s)
- Thomas E Bolhuis
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Diane E Marsman
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nathan den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Aatke van der Maas
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands.
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11
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Gay C, Kihara C, Oakley K, Patel AN, Akinsoto O. Variability of Steroid Response Time in Polymyalgia Rheumatica: A Case Report. Cureus 2022; 14:e31159. [DOI: 10.7759/cureus.31159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
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12
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Sattui SE, Jannat-Khah D, Lally L, Lieber SB, Mandl LA, Spiera RF. Prevalence of frailty in patients with polymyalgia rheumatica and association with health-related quality of life, cognition and sarcopenia. Rheumatology (Oxford) 2022; 61:4455-4464. [PMID: 35136992 PMCID: PMC9629413 DOI: 10.1093/rheumatology/keac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe the prevalence of frailty in a single-centre cohort of patients with PMR and describe its association with health-related quality of life (HRQoL), cognition and sarcopenia. METHODS This was a cross-sectional study of patients with PMR, according to 2012 EULAR/ACR Classification Criteria, presenting within 12 months of diagnosis and on treatment with glucocorticoids. Frailty was defined according to the Fried frailty criteria. HRQoL was assessed using Patient-Reported Outcomes Measurement Information System Computerized Adaptive Test (PROMIS-CAT) and cognition was assessed using the Mini-Mental State Examination. Sarcopenia was measured by DXA. RESULTS Forty-one patients were enrolled. Prevalence of frailty and pre-frailty was 17% and 59%, respectively. Frail patients had higher inflammatory markers at diagnosis compared with pre-frail and robust patients. Of 27 patients with DXA results, 26% were sarcopenic. Frail patients had worse physical function, and more pain behaviour and interference compared with pre-frail and robust patients. In univariable analyses, frail patients were more likely to have worse physical function, and more pain behaviour and pain interference, which remained significant after adjusting for age. There were no significant associations between cognition or sarcopenia and frailty. CONCLUSIONS In this cohort of PMR patients, there was a higher prevalence of frailty and pre-frailty compared with that reported in community-dwelling elderly. Frailty was associated with worse physical function, and increased pain behaviour and pain interference, differences that were also clinically meaningful. Larger prospective studies are needed to confirm these findings and analyse the association of frailty with other PMR disease outcomes.
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Affiliation(s)
- Sebastian E Sattui
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Deanna Jannat-Khah
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lindsay Lally
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sarah B Lieber
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Robert F Spiera
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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13
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Bolhuis TE, Marsman D, van den Hoogen FHJ, Broeder AAD, Broeder ND, van der Maas A. (Dis)agreement of polymyalgia rheumatica relapse criteria, and prediction of relapse in a retrospective cohort. BMC Rheumatol 2022; 6:45. [PMID: 35915465 PMCID: PMC9344672 DOI: 10.1186/s41927-022-00274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00274-y.
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Affiliation(s)
- Thomas E Bolhuis
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands. .,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Diane Marsman
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands.,Department of Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands.,Department of Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Nathan den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aatke van der Maas
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands
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14
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Muller S, Hider SL, Sokhal BS, Lawton SA, Helliwell T, Mallen CD. Long-term use of glucocorticoids for polymyalgia rheumatica: follow-up of the PMR Cohort Study. Rheumatol Adv Pract 2022; 6:rkac034. [PMID: 35591903 PMCID: PMC9113421 DOI: 10.1093/rap/rkac034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives PMR is a common inflammatory condition in older adults, characterized by bilateral hip and shoulder pain and stiffness. Reducing oral glucocorticoids, classically used for ≤2 years, are the mainstay of treatment. This study considers the factors early in the disease course that might be associated with prolonged treatment. Methods Six hundred and fifty-two people with incident PMR were recruited from English general practices (2012–2014). Participants completed seven questionnaires over 2 years (used to allocate people to pain–stiffness trajectories) and a further long-term follow-up (LTFU) questionnaire a median of 5.16 years after diagnosis. Characteristics of those still taking and having ceased glucocorticoids were described and compared using Kruskal–Wallis and χ2 and Student’s 2-sample t-tests as appropriate. Results Of the 197 people completing the LTFUQ questionnaire, 179 people reported ever having taken glucocorticoids. Of these, 40.1% were still on treatment, with a median (quartile 1, quartile 3) daily dose of 5 (1.5, 9) mg. People still taking glucocorticoids were more likely to be older (72.5 vs 70.2 years, P = 0.035), live alone (31.8 vs 15.0%, P = 0.01) and have self-managed their glucocorticoid dose (39.1 vs 11.0%, P < 0.0001). They were also more likely to belong to a pain–stiffness trajectory class with sustained symptoms. Conclusions PMR is not always a time-limited condition. Few patient characteristics are associated with prolonged treatment early in the disease course, but those who are older and who have sustained symptoms might be at greater risk. Although accurate prediction is not yet possible, clinicians should monitor people with PMR carefully to manage symptoms and reduce the cumulative glucocorticoid dose.
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Affiliation(s)
- Sara Muller
- Primary Care Centre, Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Samantha L Hider
- Primary Care Centre, Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre,Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | | | - Sarah A Lawton
- Keele Clinical Trials Unit, School of Medicine, Keele University, Keele, UK
| | - Toby Helliwell
- Primary Care Centre, Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Christian D Mallen
- Primary Care Centre, Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre,Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
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15
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Marsman DE, Bolhuis TE, den Broeder N, den Broeder AA, van der Maas A. PolyMyalgia Rheumatica treatment with Methotrexate in Optimal Dose in an Early disease phase (PMR MODE): study protocol for a multicenter double-blind placebo controlled trial. Trials 2022; 23:318. [PMID: 35428320 PMCID: PMC9012047 DOI: 10.1186/s13063-022-06263-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease affecting people older than 50, resulting in pain and stiffness of the neck, shoulder, and pelvic girdle. To date, glucocorticoids (GC) remain the cornerstone of treatment, but these have several drawbacks. Firstly, a large proportion of patients do not achieve GC-free remission within either the first (over 70%) or second year of treatment (over 50%). Secondly, GC-related adverse events (AE) occur in up to 65% of patients and can be severe. The current EULAR/ACR guidelines for PMR recommend early introduction of methotrexate (MTX) as a GC sparing agent in patients at risk for worse prognosis. However, earlier trials of low to medium quality only studied MTX dosages of 7.5–10 mg/week with no to modest effect. These doses may be suboptimal as MTX is recommended in higher doses (25 mg/week) for other inflammatory rheumatic diseases. The exact role, timing, and dose of MTX in PMR remain unclear, and therefore, our objective is to study the efficacy of MTX 25 mg/week in recently diagnosed PMR patients. Methods We set up a double-blind, randomized, placebo-controlled superiority trial (PMR MODE) to assess the efficacy of MTX 25 mg/week versus placebo in a 1:1 ratio in 100 recently diagnosed PMR patients according to the 2012 EULAR/ACR criteria. All patients will receive prednisolone 15 mg/day, tapered to 0 mg over the course of 24 weeks. In case of primary non-response or disease relapse, prednisolone dose will be temporarily increased. Assessments will take place at baseline, 4, 12, 24, 32, and 52 weeks. The primary outcome is the difference in proportion of patients in GC-free remission at week 52. Discussion No relapsing PMR patients were chosen, since the possible benefits of MTX may not outweigh the risks at low doses and effect modification may occur. Accelerated tapering was chosen in order to more easily identify a GC-sparing effect if one exists. A composite endpoint of GC-free remission was chosen as a clinically relevant endpoint for both patients and rheumatologist and may reduce second order (treatment) effects. Trial registration Dutch Trial Registration, NL8366. Registered on 10 February 2020
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16
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Falsetti P, Conticini E, Baldi C, Bardelli M, Gentileschi S, D’Alessandro R, Khayyat SGA, Cantarini L, Frediani B. Polymyalgia Rheumatica: a syndrome with an enthesitic subset? Comment on: “Use of 18F FDG PET-CT to discriminate polymyalgia rheumatica and atypical spondylarthritis in clinical practice” by Marie Pean de Ponfilly–Sotier et al. Joint Bone Spine 2021;89:105325. Joint Bone Spine 2022; 89:105378. [DOI: 10.1016/j.jbspin.2022.105378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
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17
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Emamifar A, Hess S, Ellingsen T, Gerke O, Ahangarani Farahani Z, Syrak Hansen P, Jensen Hansen IM, Thye-Rønn P. Clinical presentation and treatment response in patients with polymyalgia rheumatica and giant cell arteritis during a 40-week follow-up. Rheumatol Adv Pract 2021; 5:rkab091. [PMID: 34909566 PMCID: PMC8665449 DOI: 10.1093/rap/rkab091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives The aim was to study the clinical features of PMR/GCA and clinical predictors of treatment response during a 40-week follow-up period. Methods Clinical data on 77 patients with newly diagnosed PMR/GCA who were treated with oral glucocorticoids were gathered at baseline and during a 40-week follow-up period. A unilateral temporal artery biopsy (TAB) and 18F-fluorodeoxyglucose (18F-FDG) PET/CT were undertaken at diagnosis. In total, each patient was seen on five occasions (i.e. baseline and weeks 4, 16, 28 and 40). Treatment response was assessed by considering clinical evaluations and results of inflammatory markers. Results Of 77 patients [49 (63.6%) female; mean age 71.8 (8.0) years], 64 (83.1%) patients had pure PMR, 10 (13.0%) concomitant PMR and GCA, and 3 (3.9%) pure GCA. The patients reported that clinical symptoms, apart from scalp pain and duration of morning stiffness, improved significantly at week 4 and remained lower at week 40 compared with the relative frequencies at baseline. Besides, all components of physical examination showed significant improvement and remained lower at week 40 compared with the baseline. A complete response was seen in 68.7, 62.9, 44.1 and 33.3% of patients at weeks 4, 16, 28 and 40, respectively. Several clinical features, including female biological sex, younger age, fewer relapses and a lower level of baseline ESR, were significantly associated with a better treatment response. Treatment response during the follow-up period was independent of TAB results and fluorodeoxyglucose uptakes on 18F-FDG PET/CT at diagnosis. Conclusion Obtaining valid disease-specific outcome measures for evaluating treatment efficacy in PMR and GCA that can be applied universally is clearly an unmet clinical need. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT02985424.
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Affiliation(s)
- Amir Emamifar
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense.,Diagnostic Center.,Department of Rheumatology, Svendborg Hospital, OUH, Svendborg.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Esbjerg.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Odense University Hospital and University of Southern Denmark
| | - Oke Gerke
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark.,Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | | | | | | | - Peter Thye-Rønn
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense.,Diagnostic Center
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18
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The Effect of Transcutaneous Vagus Nerve Stimulation in Patients with Polymyalgia Rheumatica. Pharmaceuticals (Basel) 2021; 14:ph14111166. [PMID: 34832948 PMCID: PMC8621661 DOI: 10.3390/ph14111166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Polymyalgia rheumatica (PMR) is an inflammatory disease characterised by pain, morning stiffness, and reduced quality of life. Recently, vagus nerve stimulation (VNS) was shown to have anti-inflammatory effects. We aimed to examine the effect of transcutaneous VNS (t-VNS) on PMR. (2) Fifteen treatment-naïve PMR patients completed the study. Patients underwent a 5-day protocol, receiving 2 min of t-VNS stimulation bilaterally on the neck, three times daily. Cardiac vagal tone (CVT) measured on a linear vagal scale (LVS), blood pressure, heart rate, patient-reported outcome, and biochemical changes were assessed. (3) t-VNS induced a 22% increase in CVT at 20 min after initial stimulations compared with baseline (3.4 ± 2.2 LVS vs. 4.1 ± 2.9 LVS, p = 0.02) and was accompanied by a 4 BPM reduction in heart rate (73 ± 11 BPM vs. 69 ± 9, p < 0.01). No long-term effects were observed. Furthermore, t-VNS induced a 14% reduction in the VAS score for the hips at day 5 compared with the baseline (5.1 ± 2.8 vs. 4.4 ± 2.8, p = 0.04). No changes in CRP or proinflammatory analytes were observed. (4) t-VNS modulates the autonomic nervous system in patients with PMR, but further investigation of t-VNS in PMR patients is warranted.
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19
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Sugihara T. Treatment strategies for elderly-onset rheumatoid arthritis in the new era. Mod Rheumatol 2021; 32:493-499. [PMID: 34791359 DOI: 10.1093/mr/roab087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022]
Abstract
Elderly-onset rheumatoid arthritis (EORA) is characterized by acute onset and clinical features of high disease activity. Anti-cyclic citrullinated peptide antibody (ACPA) positivity or the presence of bone erosions predicts a radiological joint destruction of EORA, but ACPA-negative EORA with a polymyalgia rheumatica (PMR) phenotype may also present. Biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors were beneficial both in older and in younger patients in terms of risk-benefit balance. Implementation of a treat-to-target strategy could improve EORA outcomes, but older patients have more age-related comorbidities and interstitial lung disease than younger patients. Baseline comorbidities, more frequent methotrexate dose-dependent adverse events, serious infections, cardiovascular disease events, and malignancy all influence the choice of treatment and the treatment goals for older patients. Based on articles reviewed here, it is suggested that current treatment strategies for younger patients are also useful for ACPA-positive EORA and for ACPA-negative EORA with bone erosion. Differential diagnosis of ACPA-negative EORA without erosive arthritis and PMR with peripheral manifestations is challenging, and the treatment strategy of patients presenting with this overlap phenotype remained unclear. An appropriate treatment strategy for all patients with EORA still needs to be developed.
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Affiliation(s)
- Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Internal Medicine, Division of Rheumatology and Allergy, St. Marianna University School of Medicine, Kawasaki, Japan
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20
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Marsman DE, den Broeder N, van den Hoogen FHJ, den Broeder AA, van der Maas A. Efficacy of rituximab in patients with polymyalgia rheumatica: a double-blind, randomised, placebo-controlled, proof-of-concept trial. THE LANCET RHEUMATOLOGY 2021. [DOI: 10.1016/s2665-9913(21)00245-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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21
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Weddell J, Hider SL, Mallen CD, Muller S. What non-pharmacological treatments do people with polymyalgia rheumatica try: results from the PMR Cohort Study. Rheumatol Int 2021; 42:285-290. [PMID: 34677651 PMCID: PMC8800888 DOI: 10.1007/s00296-021-05036-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Abstract
Polymyalgia rheumatica (PMR) is common. The mainstay of treatment, glucocorticoids, are associated with significant adverse effects and many patients remain on high doses for a number of years. Little is known about the use of other, non-pharmacological therapies as adjuncts in PMR. The PMR Cohort Study is an inception cohort study of patients diagnosed with PMR in primary care. This analysis presents data on the use and perceived impact of non-pharmacological therapies from a long-term follow-up survey. Non-pharmacological treatments were classified as either diet, exercise, or complementary therapies. Results are presented as adjusted means, medians, and raw counts where appropriate. One hundred and ninety-seven participants completed the long-term follow-up questionnaire, of these 81 (41.1%) reported using non-pharmacological therapy. Fifty-seven people reported using a form of complementary therapy, 35 used exercise and 20 reported changing their diet. No individual non-pharmacological therapy appeared to be associated with long-term outcomes. The use of non-pharmacological therapies is common amongst PMR patients, despite the paucity of evidence supporting their use. This suggests that people perceive a need for treatment options in addition to standard glucocorticoid regimens. Further research is needed to understand patients’ aims when seeking additional treatments and to strengthen the evidence base for their use so that patients can be guided towards effective options.
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Affiliation(s)
- Jake Weddell
- School of Medicine, Keele University, Keele, Staffordshire, UK.
| | - Samantha L Hider
- School of Medicine, Keele University, Keele, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | | | - Sara Muller
- School of Medicine, Keele University, Keele, Staffordshire, UK
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22
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Chrysidis S, Lage-Hansen PR, Svendsen N, Diamantopoulos AP. The fast-track outpatient clinic significantly decreases hospitalisation rates among polymyalgia rheumatica patients. BMC Rheumatol 2021; 5:37. [PMID: 34607614 PMCID: PMC8491370 DOI: 10.1186/s41927-021-00210-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives This study aimed to investigate the hospitalisation rates and the reasons for hospitalisation in patients with polymyalgia rheumatica (PMR). Furthermore, it aimed to clarify the impact of a newly established Fast Track Clinic (FTC) approach on hospitalisation rates in connection with PMR diagnosis. Methods Patients diagnosed with PMR at South-West Jutland Hospital, Denmark, between 2013 and 2018 were included retrospectively. Only patients fulfilling the 2012 EULAR/ACR classification criteria were included in our cohort. An FTC for patients suspected of having PMR was established in the rheumatologic department of South-West Jutland Hospital in January 2018. Results Over 6 years (2013 to 2017), 254 patients were diagnosed with PMR, 56 of them while hospitalised. Hospitalised patients were more likely to have a higher initial CRP mean ± standard deviation (SD) 99.53 ± 59.36 vs 45.82 ± 36.96 mg/lt (p < 0.0001) and a shorter duration of symptoms (p = 0.0018). After implementing the FTC, a significant decrease in hospitalisation rates (from 20.4% to 3,5%) and inpatient days of care (mean ± SD 4.15 ± 3.1 vs 1 ± 0) were observed. No differences between the two groups were observed regarding clinical symptoms, laboratory values and initial prednisolone dose. Conclusion A substantial number of patients are hospitalised in connection with the PMR diagnosis. The FTC approach can decrease the hospitalisation rates significantly among these patients. Trial registration Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00210-6.
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Affiliation(s)
- Stavros Chrysidis
- Department of Rheumatology, South-west Jutland Hospital, Finsensgade 35, 6700, Esbjerg, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Philip Rask Lage-Hansen
- Department of Rheumatology, South-west Jutland Hospital, Finsensgade 35, 6700, Esbjerg, Denmark
| | - Nikoletta Svendsen
- Department of Rheumatology, South-west Jutland Hospital, Finsensgade 35, 6700, Esbjerg, Denmark
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23
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Depression and depressive symptoms in patients with polymyalgia rheumatica: discussion points, grey areas and unmet needs emerging from a systematic review of published literature. Reumatologia 2021; 58:381-389. [PMID: 33456081 PMCID: PMC7792545 DOI: 10.5114/reum.2020.102003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/30/2020] [Indexed: 01/11/2023] Open
Abstract
Objectives In 1979, Bird et al. proposed depression as a diagnostic criterion for polymyalgia rheumatica (PMR). More recently, the significance of depression in PMR patients has been re-proposed, , and some researchers have suggested that PMR may increase the risk of depression. The aim of our article is to evaluate the relationship between PMR and depression. Material and methods Systematic literature searches were performed on 19th and 20th May 2020 based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The search was restricted to all studies and case reports with English abstract, published in any language, since 1979 (when depression was first proposed as a diagnostic criterion for PMR) describing the association of PMR with depression. Exclusion criteria were as follows: reviews, conference abstracts, comments, non-original articles; and articles discussing giant cell arteritis (GCA) and PMR when data and observations for the two conditions were not clearly subdivided. Results The initial search yielded 812 papers, of which 115 duplicates were removed. A total of 697 articles had a first screening and 506 were excluded based on title and abstract reviews; 117 articles underwent full-length scrutiny, and 99 full-text articles were excluded because they did not meet the inclusion and exclusion criteria (reviews and comments = 58; articles with outcome of interest not reported = 34; low-quality articles = 7). At least, 18 articles were included in this review. Conclusions The review did not find any studies that clarified the prevalence rates of depression in patients with PMR. Furthermore, the studies reviewed did not offer any clarity as to whether patients suffered from just depressive symptoms or clinical depression, and that accepted diagnostic criteria for depression had not been employed, indicating that a robust method for diagnosing depression had not been employed. Collaboration of different professionals should be improved through shared guidelines.
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24
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Leung JL, Owen CE, Buchanan RRC, Liew DFL. Management of polymyalgia rheumatica in older people. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jessica L. Leung
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
| | - Claire E. Owen
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
| | - Russell R. C. Buchanan
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
| | - David F. L. Liew
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
- Department of Clinical Pharmacology and Therapeutics Austin Health Melbourne Australia
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25
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Manzo C, Emamifar A. Polymyalgia Rheumatica and Seronegative Elderly-Onset Rheumatoid Arthritis: Two Different Diseases with Many Similarities. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10313508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Polymyalgia rheumatica (PMR) and seronegative elderly-onset rheumatoid arthritis (SEORA) are two of the most frequent inflammatory rheumatologic diseases in elderly patients. At first presentation, there are many similarities between PMR and SEORA, that may lead to a real diagnostic conundrum. The most relevant similarities and differences between PMR and SEORA are discussed in this review. In addition to the acute involvement of the shoulder joints, important features characterising both diseases are morning stiffness longer than 45 minutes, raised erythrocyte sedimentation rate, and a good response to low doses of prednisone. Some findings (such as erosive arthritis or symmetrical involvement of metacarpophalangeal and/or proximal interphalangeal joints) can help to make the diagnosis of SEORA, whereas shoulder and hip ultrasonography and 18-FDG PET/CT seem to be less specific. However, in several patients only long-term follow-ups confirm the initial diagnosis. A definite diagnosis of PMR or SEORA has significant therapeutic implications, since patients with PMR should be treated with long-term glucocorticoids, and sometimes throughout life, which predisposes the patients to serious side effects. On the contrary, in patients with SEORA, short-term treatment with glucocorticoids should be considered when initiating or changing disease modifying antirheumatic drugs, followed by rapid tapering.
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Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic Hospital “Mariano Lauro”, Sant’Agnello, Italy
| | - Amir Emamifar
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Diagnostic Center, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
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26
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Grygiel-Górniak B, Limphaibool N, Puszczewicz M. Cytokine secretion and the risk of depression development in patients with connective tissue diseases. Psychiatry Clin Neurosci 2019; 73:302-316. [PMID: 30719813 DOI: 10.1111/pcn.12826] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/16/2019] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
Research in the past two decades has revolutionized our understanding of depressive illnesses. Proinflammatory cytokines have become a point of interest in the interconnecting areas of neuropsychiatric and autoimmune diseases. The cytokine hypothesis of depression suggests that pro-inflammatory cytokines play a primary role in the mediation of the pathophysiological characteristics of major depression, in which an inflammatory process may be induced by external and internal stressors, such as psychological and inflammatory diseases, respectively. The higher prevalence of depression, particularly in patients with chronic autoimmune connective tissue disorders (CTD), suggests that depression may present a dysfunctional adaptation of cytokine-induced sickness, which could manifest in times of an exacerbated activation of the innate immune system. Inflammation is thought to contribute to the development of clinical depression through its ability to induce sickness behaviors corresponding to the neurovegetative features of depression, through the dysregulation of the hypothalamic-pituitary-adrenal axis, alterations in neurotransmitter synthesis and reuptake, and through its involvement in the neuroprogression pathways. This review explores the complex interrelationships in which inflammatory responses alter neuroendocrine and neuropsychological regulation contributing to depressive symptoms in CTD. The prevalence and characteristics of depression, and its correlation to the levels of inflammatory cytokines and disease activity among different CTD will be reviewed.
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Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Nattakarn Limphaibool
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariusz Puszczewicz
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
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Tani K, Kawaminami S, Okura Y, Tabata R, Yuasa S, Nakanishi Y, Kawahito K, Inaba K, Inaba K, Kondo K, Umetani K, Miyatake A, Suzuki Y, Yamaguchi H. Predictive factors associated with the therapeutic response in patients with polymyalgia rheumatica and remitting seronegative symmetrical synovitis with pitting edema syndrome. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:112-118. [DOI: 10.2152/jmi.66.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kenji Tani
- General Medicine and Primary Care, Tokushima University Hospital, Tokushima, Japan
| | - Shingo Kawaminami
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Yoshihiro Okura
- General Medicine and Primary Care, Tokushima University Hospital, Tokushima, Japan
| | - Ryo Tabata
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Shino Yuasa
- Tokushima Prefectural Central Hospital, Tokushima,Japan
| | - Yoshinori Nakanishi
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | | | - Keisuke Inaba
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Kaori Inaba
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | | | | | | | - Yoshihiro Suzuki
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Harutaka Yamaguchi
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
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28
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Morton C, Muller S, Bucknall M, Gilbert K, Mallen CD, Hider SL. Examining management and research priorities in patients with polymyalgia rheumatica: a primary care questionnaire survey. Clin Rheumatol 2019; 38:1767-1772. [PMID: 30617599 PMCID: PMC6544756 DOI: 10.1007/s10067-018-04405-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/16/2018] [Indexed: 11/25/2022]
Abstract
Introduction/objectives Polymyalgia rheumatica (PMR) is a common inflammatory disorder that is usually managed with oral glucocorticoids, which although effective can cause significant adverse events. Support group survey data suggests length of glucocorticoid treatment and managing side effects are key priority areas of management for patients. Recognising that not all patients will access patient support organisations, our objective was to identify priorities for PMR management and research among primary care PMR patients. Method All adults aged ≥ 50 years registered with 150 English general practices who had a first read code for PMR in their medical records in the preceding 3 years were mailed a self-completion questionnaire (n = 704). Survey items included questions regarding patient priorities for PMR management (from a pre-defined list of 10 items) and suggestions for future research (8 items, plus a free-text option), which were developed in collaboration with PMRGCAuk. Results Five hundred fifty patients responded (78%). The mean (SD) age was 74.1 (8.5) years and 361 (66%) were female. Priority research areas were focused on how to better manage pain, stiffness and fatigue (431, 78%), improving the diagnosis of PMR (393, 71%) and steroid management (342, 62%). Conclusions This survey of PMR patients suggests that symptom management, early diagnosis and managing medication are key areas for patients for future research. Researchers and funding organisations should be aware of these priorities if we are to generate research findings that are relevant to the widest range of stakeholders.
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Affiliation(s)
- Chris Morton
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
| | - Sara Muller
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milica Bucknall
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | | | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Samantha L Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stafford, UK
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29
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Clinical Improvement According to RAPID3 in Patients With Polymyalgia Rheumatica. J Clin Rheumatol 2018; 24:390-392. [DOI: 10.1097/rhu.0000000000000701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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González-Gay MA, Pina T, Prieto-Peña D, Calderon-Goercke M, Blanco R, Castañeda S. Drug therapies for polymyalgia rheumatica: a pharmacotherapeutic update. Expert Opin Pharmacother 2018; 19:1235-1244. [DOI: 10.1080/14656566.2018.1501360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Miguel A. González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Faculty of Medicine, University of Cantabria, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Trinitario Pina
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Diana Prieto-Peña
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Mónica Calderon-Goercke
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Ricardo Blanco
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Santos Castañeda
- Rheumatology Division, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Abstract
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are related inflammatory diseases of adults aged 50 years or older. The diagnosis of PMR is based on morning stiffness, proximal shoulder and pelvic girdle pain, and functional impairment. GCA is characterized by headache, jaw claudication, and visual disturbances. Constitutional symptoms and elevated inflammatory markers are common to both conditions. Temporal artery biopsy remains the gold standard for diagnosis of GCA. Glucocorticoids are the cornerstone of therapy, with tapering regimens individualized to the patient. Prompt diagnosis and treatment are essential to avert vision loss in GCA. Tocilizumab increases remission rates in GCA.
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Affiliation(s)
- Mathilde H Pioro
- Department of Rheumatology, Orthopedic and Rheumatologic Institute, Cleveland Clinic, 9500 Euclid Avenue A50, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue A50, Cleveland, OH 44195, USA.
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Preliminary concurrent validity of the Fitbit-Zip and ActiGraph activity monitors for measuring steps in people with polymyalgia rheumatica. Gait Posture 2018; 61:339-345. [PMID: 29427859 DOI: 10.1016/j.gaitpost.2018.01.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Activity monitors provide objective measurements of physical activity, however, the accuracy of these devices in people with polymyalgia rheumatica (PMR) is unknown. Therefore, this study aimed to obtain preliminary evidence of the accuracy of two activity monitors and explore if clinical and gait-related factors altered device accuracy in people with PMR. METHODS The ActiGraph with low frequency extension (+LFE) and standard (-LFE) algorithms, Fitbit-Zip (waist) and Fitbit-Zip (shirt) were concurrently tested using a two-minute walk test (2MWT) and stairs test in 27 people with PMR currently treated with prednisolone. To determine accuracy, activity monitor step-count was compared to a gold-standard step-count (GSSC; calculated from video recording) using Bland-Altman plots. RESULTS The Fitbit-Zip (waist) achieved closest agreement to the GSSC for the 2MWT (mean bias (95%CI): 10 (-3, 23); 95%LOA: -55, 74). The ActiGraph (+LFE) achieved closest agreement to the GSSC for the stairs test (mean bias (95%CI): 0 (-1, 1); 95%LOA: -5, 5). The ActiGraph (-LFE) performed poorly in both tests. All devices demonstrated reduced accuracy in participants with lower gait velocity, reduced stride length, longer double-limb support phase and greater self-reported functional impairment. CONCLUSION Our preliminary results suggest that in controlled conditions, the Fitbit-Zip fairly accurately measures step-count during walking in people with PMR receiving treatment. However, device error was greater than data published in healthy people. The ActiGraph may not be recommended without activation of the LFE. We identified clinical and gait-related factors associated with higher levels of functional impairment that reduced device accuracy. Further work is required to evaluate the validity of the activity monitors in field conditions.
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Lai LYH, Harris E, West RM, Mackie SL. Association between glucocorticoid therapy and incidence of diabetes mellitus in polymyalgia rheumatica and giant cell arteritis: a systematic review and meta-analysis. RMD Open 2018. [PMID: 29531778 PMCID: PMC5845432 DOI: 10.1136/rmdopen-2017-000521] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are almost always treated with glucocorticoids (GCs), but long-term GC use is associated with diabetes mellitus (DM). The absolute incidence of this complication in this patient group remains unclear. Objective To quantify the absolute risk of GC-induced DM in PMR and GCA from published literature. Methods We identified literature from inception to February 2017 reporting diabetes following exposure to oral GC in patients with PMR and/or GCA without pre-existing diabetes. A random-effects meta-analysis was performed to summarise the findings. Results 25 eligible publications were identified. In studies of patients with GCA, mean cumulative GC dose was almost 1.5 times higher than in studies of PMR (8.2 g vs 5.6 g), with slightly longer treatment duration and longer duration of follow-up (6.4 years vs 4.4 years). The incidence proportion (cumulative incidence) of patients who developed new-onset DM was 6% (95% CI 3% to 9%) for PMR and 13% (95% CI 9% to 17%) for GCA. Based on UK data on incidence rate of DM in the general population, the expected background incidence rate of DM over 4.4 years in patients with PMR and 6.4 years in patients with GCA (follow-up duration) would be 4.8% and 7.0%, respectively. Heterogeneity between studies was high (I2=79.1%), as there were differences in study designs, patient population, geographical locations and treatment. Little information on predictors of DM was found. Conclusion Our meta-analysis produced plausible estimates of DM incidence in patients with PMR and GCA, but there is insufficient published data to allow precise quantification of DM risk.
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Affiliation(s)
- Lana Yin Hui Lai
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Emma Harris
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sarah Louise Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Mizoribine is as Effective as Methotrexate for the Treatment of Polymyalgia Rheumatica: A Retrospective Case Series Analysis. Arch Rheumatol 2018; 33:302-308. [PMID: 30632539 DOI: 10.5606/archrheumatol.2018.6418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 10/23/2017] [Indexed: 01/31/2023] Open
Abstract
Objectives This study aims to evaluate the efficacy and safety of mizoribine (MZR) as a steroid-sparing agent compared to methotrexate (MTX) in the treatment of polymyalgia rheumatica in elderly patients. Patients and methods Twenty-four patients (9 males, 15 females; mean age 71.7 years; range 50 to 86 years) diagnosed with polymyalgia rheumatica between April 1998 and August 2014, who received prednisone in combination with either MTX or MZR, were included. We collected the data on the cumulative prednisone dose that patients received within 48 weeks after MTX or MZR and its side effect profile. Results There were 10 patients in the MTX group and 14 in the MZR group. The cumulative prednisone dose over 0-48 weeks was 2272±396 mg in the MTX group and 1907±241 mg in the MZR group, which was not significantly different (p=0.41). In terms of side effects, in the MTX group, three patients experienced a transient elevation in liver enzymes, and one patient developed gastrointestinal symptoms that led to MTX withdrawal. In the MZR group, one patient was hospitalized due to pneumonia that led to MZR withdrawal. Conclusion Mizoribine was non-inferior to MTX in terms of steroid-sparing effects on polymyalgia rheumatica. Also, MZR tended to have fewer side effects than MTX.
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González-Gay MA, Matteson EL, Castañeda S. Polymyalgia rheumatica. Lancet 2017; 390:1700-1712. [PMID: 28774422 DOI: 10.1016/s0140-6736(17)31825-1] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022]
Abstract
Polymyalgia rheumatica is an inflammatory disease that affects the shoulder, the pelvic girdles, and the neck, usually in individuals older than 50 years. Increases in acute phase reactants are typical of polymyalgia rheumatica. The disorder might present as an isolated condition or in association with giant cell arteritis. Several diseases, including inflammatory rheumatic and autoimmune diseases, infections, and malignancies can mimic polymyalgia rheumatica. Imaging techniques have identified the presence of bursitis in more than half of patients with active disease. Vascular uptake on PET scans is seen in some patients. A dose of 12·5-25·0 mg prednisolone daily or equivalent leads to rapid improvement of symptoms in most patients with isolated disease. However, relapses are common when prednisolone is tapered. Methotrexate might be used in patients who relapse. The effectiveness of biological therapies, such as anti-interleukin 6, in patients with polymyalgia rheumatica that is refractory to glucocorticoids requires further investigation. Most population-based studies indicate that mortality is not increased in patients with isolated disease.
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Affiliation(s)
- Miguel A González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Eric L Matteson
- Division of Rheumatology and Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Santos Castañeda
- Rheumatology Division, Hospital de La Princesa, Instituto de Investigación Sanitaria-Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Mackie SL, Twohig H, Neill LM, Harrison E, Shea B, Black RJ, Kermani TA, Merkel PA, Mallen CD, Buttgereit F, Mukhtyar C, Simon LS, Hill CL. The OMERACT Core Domain Set for Outcome Measures for Clinical Trials in Polymyalgia Rheumatica. J Rheumatol 2017; 44:1515-1521. [PMID: 28765246 DOI: 10.3899/jrheum.161109] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To inform development of a core domain set for outcome measures for clinical trials in polymyalgia rheumatica (PMR), we conducted patient consultations, a systematic review, a Delphi study, and 2 qualitative studies. METHODS Domains identified by 70% or more of physicians and/or patients in the Delphi study were selected. The conceptual framework derived from the 2 qualitative research studies helped inform the meaning of each domain and its relationship to the others. The draft core domain set was refined by further discussion with patients and physicians who had participated in the Delphi study. At the Outcome Measures in Rheumatology (OMERACT) 2016, the domains were discussed and prioritized by 8 breakout groups. Formal voting took place at the end of the workshop and in the final plenary. RESULTS Ninety-three percent of voters in the final plenary agreed that the inner core of domains considered mandatory for clinical trials of PMR should consist the following: laboratory markers of systemic inflammation, pain, stiffness, and physical function. Patient's global and fatigue were considered important but not mandatory (outer core). The research agenda included psychological impact, weakness, physical activity, participation, sleep, imaging, and health-related quality of life. CONCLUSION This core domain set was considered sufficiently well-defined that the next step will be to apply the OMERACT Filter 2.0 Instrument Selection Algorithm to select candidate instruments for a subsequent "deeper dive" into the data. This will allow instruments to be mapped onto each of our core domains to derive a core outcome set for PMR.
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Affiliation(s)
- Sarah L Mackie
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany. .,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital.
| | - Helen Twohig
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Lorna M Neill
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Eileen Harrison
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Beverley Shea
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Rachel J Black
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Tanaz A Kermani
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Peter A Merkel
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Christian D Mallen
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Frank Buttgereit
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Chetan Mukhtyar
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Lee S Simon
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Catherine L Hill
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, and UK National Institute for Health Research (NIHR), Leeds; Academic Unit of Primary Medical Care, University of Sheffield, Sheffield; PMR-GCA Scotland, Dundee; PMR-GCA North East, Gateshead; Primary Care and Health Sciences, Keele University, Keele; Norfolk and Norwich University Hospital, Norwich, UK; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, California; Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; SDG LLC, Cambridge, Massachusetts, USA; Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.,S.L. Mackie, BM, BCh, PhD, Associate Clinical Professor and Honorary Consultant Rheumatologist, LIRM, University of Leeds; H. Twohig, MBChB, General Practitioner, Academic Unit of Primary Medical Care, University of Sheffield; L.M. Neill, BSc, PMR-GCA Scotland and OMERACT Patient Research Partner; E. Harrison, BSc, PMR-GCA North East and OMERACT Patient Research Partner; B. Shea, PhD, Senior Methodologist and Adjunct Professor, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R.J. Black, MBBS, Consultant Rheumatologist and Clinical Lecturer, Discipline of Medicine, The University of Adelaide; T.A. Kermani, MD, MS, Assistant Clinical Professor, Division of Rheumatology, UCLA; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; C.D. Mallen, PhD, NIHR Research Professor in General Practice, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care, Keele University; F. Buttgereit, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin; C. Mukhtyar, MD, Consultant Rheumatologist, Norfolk and Norwich University Hospital; L.S. Simon, MD, Principal, SDG LLC; C.L. Hill, MD, Clinical Professor and Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital
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Cawley A, Prior JA, Muller S, Helliwell T, Hider SL, Dasgupta B, Barraclough K, Mallen CD. Association between characteristics of pain and stiffness and the functional status of patients with incident polymyalgia rheumatica from primary care. Clin Rheumatol 2017. [PMID: 28634698 PMCID: PMC5948286 DOI: 10.1007/s10067-017-3730-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper aims to examine the relationship between different characteristics of pain and stiffness and the functional status of patients with newly diagnosed polymyalgia rheumatica (PMR). Baseline analysis of an inception cohort study was conducted. Patients aged ≥18 years, with a new diagnosis of PMR were recruited from 382 English general practices. Participants were mailed a baseline questionnaire, including separate pain and stiffness manikins and numerical rating scales (NRS), a question on their ability to raise their arms above their head and the modified Health Assessment Questionnaire (mHAQ) to examine participants’ functional status. Linear regression analysis, reported as regression co-efficients (95% confidence intervals (95% CI)), was used to assess the association of pain and stiffness with function, initially unadjusted and then adjusted for age, gender, deprivation status, smoking status, BMI, anxiety and depression. Six hundred fifty two patients responded to the baseline survey (88.5%). The majority (88.2%) reported no, or mild impairment in their functional status. Adjusted linear regression analysis demonstrated that high (NRS ≥8) pain (0.20 (95% CI 0.10–0.28)) or stiffness (0.18 (0.09–0.26)) ratings, an increasing number of sites of pain (0.18 (0.06–0.29)) or stiffness (0.19 (0.08–0.31)) and shoulder pain (0.18 (0.05–0.31)), stiffness (0.10 (0.01–0.20)) and difficulty raising arms above one’s head (0.19 (0.10–0.28)) were all associated with increased functional impairment. The majority of newly diagnosed PMR patients reported no or minimal functional difficulty. However, those who experience severe or widespread pain or stiffness often have significant functional limitation in performing their daily activities and may be a subset worthy of additional focus in primary care.
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Affiliation(s)
- A Cawley
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, ST5 5BG, UK
| | - J A Prior
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, ST5 5BG, UK.
| | - S Muller
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, ST5 5BG, UK
| | - T Helliwell
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, ST5 5BG, UK
| | - S L Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, ST5 5BG, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, Staffordshire, UK
| | - B Dasgupta
- Southend University Hospital, Westcliff-on-Sea, UK
| | | | - C D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, ST5 5BG, UK
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How common is depression in patients with polymyalgia rheumatica? Clin Rheumatol 2017; 37:1633-1638. [DOI: 10.1007/s10067-017-3691-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/25/2017] [Accepted: 05/18/2017] [Indexed: 11/26/2022]
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Tuckwell K, Collinson N, Dimonaco S, Klearman M, Blockmans D, Brouwer E, Cid MC, Dasgupta B, Rech J, Salvarani C, Unizony SH, Stone JH. Newly diagnosed vs. relapsing giant cell arteritis: Baseline data from the GiACTA trial. Semin Arthritis Rheum 2017; 46:657-664. [DOI: 10.1016/j.semarthrit.2016.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
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Matsui K, Maruoka M, Yoshikawa T, Hashimoto N, Nogami M, Sekiguchi M, Azuma N, Kitano M, Tsunoda S, Sano H. Assessment of 2012 EULAR/ACR new classification criteria for polymyalgia rheumatica in Japanese patients diagnosed using Bird's criteria. Int J Rheum Dis 2017; 21:497-501. [DOI: 10.1111/1756-185x.13006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kiyoshi Matsui
- Division of Rheumatology Department of Internal Medicine; Hyogo College of Medicine; Hyogo Japan
| | - Momo Maruoka
- Division of Rheumatology Department of Internal Medicine; Hyogo College of Medicine; Hyogo Japan
| | - Takahiro Yoshikawa
- Division of Rheumatology Department of Internal Medicine; Hyogo College of Medicine; Hyogo Japan
| | - Naoaki Hashimoto
- Division of Rheumatology Department of Internal Medicine; Hyogo College of Medicine; Hyogo Japan
- Hashimoto Clinic for Rheumatic Diseases; Osaka Japan
| | - Mika Nogami
- Okabe Clinic for General Medicine; Zentsuji Kagawa Japan
| | - Masahiro Sekiguchi
- Division of Rheumatology Department of Internal Medicine; Hyogo College of Medicine; Hyogo Japan
| | - Naoto Azuma
- Division of Rheumatology Department of Internal Medicine; Hyogo College of Medicine; Hyogo Japan
| | - Masayasu Kitano
- Division of Rheumatology Department of Internal Medicine; Hyogo College of Medicine; Hyogo Japan
| | - Shinichiro Tsunoda
- Division of Rheumatology Department of Internal Medicine; Hyogo College of Medicine; Hyogo Japan
| | - Hajime Sano
- Division of Rheumatology Department of Internal Medicine; Hyogo College of Medicine; Hyogo Japan
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Miceli MC, Zoli A, Peluso G, Bosello S, Gremese E, Ferraccioli G. Baseline Shoulder Ultrasonography Is Not a Predictive Marker of Response to Glucocorticoids in Patients with Polymyalgia Rheumatica: A 12-month Followup Study. J Rheumatol 2016; 44:241-247. [PMID: 27980012 DOI: 10.3899/jrheum.160090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/22/2022]
Abstract
Objective.In this study, we evaluated whether ultrasound (US) subdeltoid bursitis (SB) and/or biceps tenosynovitis (BT) presence at baseline could represent a predictive marker of response to standard therapy after 12 months of followup, and whether a positive US examination could highlight the need of higher maintenance dosage of glucocorticoids (GC) at 6 and 12 months in patients with polymyalgia rheumatica (PMR).Methods.Sixty-six consecutive patients with PMR underwent bilateral shoulder US evaluations before starting therapy and after 12 months of followup. Absence of girdle pain and morning stiffness (clinical remission) and laboratory variables were evaluated. After diagnosis, all patients were treated with prednisone.Results.At baseline, SB and/or BT were present in 46 patients (70%), of whom 33 (72%) became negative while 13 (28%) remained positive at the 12-month US evaluation. All patients rapidly achieved a clinical remission, and at 6 months 26 (39%) also achieved a laboratory variable normalization. According to US positivity at baseline, no difference was found in remission or relapse rate after 12 months. Thirty patients (46%) at 6 months and 7 (11%) at 12 months were still taking more than 5 mg/day of prednisone. According to the US pattern at baseline, no difference was found in the mean GC dose at 6 and 12 months.Conclusion.In patients with PMR, the presence of SB and/or BT on US at diagnosis is not a predictive marker of GC response or of a higher GC dosage to maintain remission in a 12-month prospective followup study.
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Brawer AE. Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment. Open Access Rheumatol 2016; 8:45-49. [PMID: 27843369 PMCID: PMC5098760 DOI: 10.2147/oarrr.s101911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives The diagnostic diversity of polymyalgia rheumatica (PMR) can easily be obscured by the widespread use of corticosteroids (CSs) early in the disease course. This study observed the course of PMR without CSs and determined whether alternative medication could be useful. Methods Seventy patients with new-onset PMR comprised phase 1. Eight were removed with specific diagnoses (four with giant cell arteritis [GCA]). The remaining 62 were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone until enough time had elapsed to ascertain whether their PMR had evolved into another rheumatologic inflammatory condition. Hydroxychloroquine (HCQ) was then added to their regimen. Twenty-five additional patients with PMR comprised phase 2. Twenty-two were immediately treated with HCQ prior to the anticipated disease progression. Results In phase 1, 52/62 developed synovitis in multiple other joints 9 months from PMR onset; 48/52 received HCQ, and 42/48 (87.5%) achieved complete remission. In phase 2, during HCQ induction, 21 patients developed similar synovitis; after 6 months of HCQ use, 80% achieved remission. In 73/95 (77%), a definite diagnosis of rheumatoid arthritis (RA) could be made on average 8.5 months from PMR onset. Only 12/95 (13%) stayed true to form with their PMR and did not develop another specific diagnosis. Conclusion In this study, true PMR was infrequent in the absence of GCA. PMR in most patients evolved into seronegative RA, which was dramatically responsive to HCQ use. Treatment of acute PMR with HCQ was a rational alternative to CS use even if progressive additive synovitis had not yet occurred.
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Affiliation(s)
- Arthur E Brawer
- Division of Rheumatology, Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA
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Muratore F, Pazzola G, Pipitone N, Salvarani C. Recent advances in the diagnosis and treatment of polymyalgia rheumatica. Expert Rev Clin Immunol 2016; 12:1037-45. [DOI: 10.1080/1744666x.2016.1178572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, Abril A, Bachta A, Balint P, Barraclough K, Bianconi L, Buttgereit F, Carsons S, Ching D, Cid M, Cimmino M, Diamantopoulos A, Docken W, Duftner C, Fashanu B, Gilbert K, Hildreth P, Hollywood J, Jayne D, Lima M, Maharaj A, Mallen C, Martinez-Taboada V, Maz M, Merry S, Miller J, Mori S, Neill L, Nordborg E, Nott J, Padbury H, Pease C, Salvarani C, Schirmer M, Schmidt W, Spiera R, Tronnier D, Wagner A, Whitlock M, Matteson EL, Dasgupta B. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheumatol 2016; 67:2569-80. [PMID: 26352874 DOI: 10.1002/art.39333] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/13/2015] [Indexed: 12/12/2022]
Abstract
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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Affiliation(s)
- Christian Dejaco
- Medical University Graz, Department of Rheumatology, Graz, Austria, and Southend University Hospital, Department of Rheumatology, Essex, UK
| | - Yogesh P Singh
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, Epidemiology and Population Health Faculty, London, UK
| | - Andrew Hutchings
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, UK
| | - Dario Camellino
- University of Genoa, Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, Genoa, Italy
| | - Sarah Mackie
- University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Andy Abril
- Mayo Clinic, Department of Rheumatology, Jacksonville, Florida
| | - Artur Bachta
- Military Institute of Medicine, Department of Internal Medicine and Rheumatology, Warsaw, Poland
| | - Peter Balint
- National Institute of Rheumatology and Physiotherapy, 3rd Rheumatology Department, Budapest, Hungary
| | | | | | - Frank Buttgereit
- Charité University Medicine, Department of Rheumatology, Berlin, Germany
| | - Steven Carsons
- Stony Brook University School of Medicine, Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital Campus, Mineola, New York
| | - Daniel Ching
- Timaru Hospital, Department of Rheumatology, Timaru, New Zealand
| | - Maria Cid
- University of Barcelona Hospital Clinic, Department of Systemic Autoimmune Diseases, Barcelona, Spain
| | - Marco Cimmino
- University of Genoa, Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, Genoa, Italy
| | | | - William Docken
- Brigham and Women's Hospital, Division of Rheumatology, Boston, Massachusetts
| | - Christina Duftner
- Medical University of Innsbruck, Department of Internal Medicine-Clinic VI, Innsbruck, Austria
| | - Billy Fashanu
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | - Kate Gilbert
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Pamela Hildreth
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Jane Hollywood
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | - David Jayne
- University of Cambridge, Department of Medicine, Cambridge, UK
| | - Manuella Lima
- Hospital Universitário Pedro Ernesto, Department of Rheumatology, Rio de Janeiro, Brazil
| | - Ajesh Maharaj
- University of Kwa Zulu Natal, Prince Mshiyeni Memorial Hospital, Nelson R. Mandela School of Medicine, Department of Internal Medicine, Durban, South Africa
| | - Christian Mallen
- Keele University, Arthritis Research UK Primary Care Centre, Keele, UK
| | - Victor Martinez-Taboada
- Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Servicio de Reumatología, Santander, Spain
| | - Mehrdad Maz
- University of Kansas Medical Center, Department of Medicine, Division of Allergy, Clinical Immunology, and Rheumatology, Kansas City
| | - Steven Merry
- Mayo Clinic, Department of Family Medicine, Rochester, Minnesota
| | - Jean Miller
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Shunsuke Mori
- NHO Kumamoto Saishunsou National Hospital, Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, Kohshi, Kumamoto, Japan
| | - Lorna Neill
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Elisabeth Nordborg
- Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
| | - Jennifer Nott
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Hannah Padbury
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Colin Pease
- University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Carlo Salvarani
- Azienda Ospedaliera-IRCCS di Reggio Emilia, Department of Internal Medicine, Division of Rheumatology, Reggio Emilia, Italy
| | - Michael Schirmer
- Medical University of Innsbruck, Department of Internal Medicine-Clinic VI, Innsbruck, Austria
| | - Wolfgang Schmidt
- Immanuel Krankenhaus Berlin and Medical Center for Rheumatology Berlin-Buch, Berlin, Germany
| | - Robert Spiera
- Hospital for Special Surgery, Department of Medicine, New York, New York
| | - David Tronnier
- patient representative from the Mayo Clinic, Rochester, Minnesota
| | - Alexandre Wagner
- Universidade Federal de São Paulo, Department of Internal Medicine, São Paulo, Brazil
| | | | - Eric L Matteson
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Division of Rheumatology, Rochester, Minnesota
| | - Bhaskar Dasgupta
- Southend University Hospital, Department of Rheumatology, Essex, UK
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Patient-reported outcomes in trials of patients with polymyalgia rheumatica: a systematic literature review. Rheumatol Int 2016; 36:897-904. [DOI: 10.1007/s00296-015-3416-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
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Steel L, Bukhari M, Dasgupta B. 2015 EULAR-ACR recommendations for polymyalgia rheumatica: the message and next steps. Rheumatology (Oxford) 2015; 55:955-6. [PMID: 26683194 DOI: 10.1093/rheumatology/kev406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lauren Steel
- Department of Rheumatology, Southend University Hospital, Essex and
| | - Marwan Bukhari
- University Hospitals of Morecambe Bay NHS foundation trust, Royal Lancaster Infirmary, Lancaster, UK
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University Hospital, Essex and
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Buttgereit F, Matteson EL. Imaging: Whole-body MRI undresses polymyalgia rheumatica. Nat Rev Rheumatol 2015; 12:140-1. [PMID: 26633289 DOI: 10.1038/nrrheum.2015.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Frank Buttgereit
- Department of Rheumatology &Clinical Immunology, Charité - University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Eric L Matteson
- Mayo Clinic College of Medicine, Division of Rheumatology and Division of Epidemiology, Departments of Internal Medicine and Health Sciences Research; 200 1st Street SW, Rochester, Minnesota, USA
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Mackie SL, Pease CT, Fukuba E, Harris E, Emery P, Hodgson R, Freeston J, McGonagle D. Whole-body MRI of patients with polymyalgia rheumatica identifies a distinct subset with complete patient-reported response to glucocorticoids. Ann Rheum Dis 2015; 74:2188-92. [PMID: 26376658 PMCID: PMC4680120 DOI: 10.1136/annrheumdis-2015-207395] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/22/2015] [Accepted: 07/14/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether whole-body MRI defines clinically relevant subgroups within polymyalgia rheumatica (PMR) including glucocorticoid responsiveness. METHODS 22 patients with PMR and 16 with rheumatoid arthritis (RA), untreated and diagnosed by consultant rheumatologists, underwent whole-body, multiple-joint MRI, scored by two experts. Patients with PMR reported whether they felt 'back to normal' on glucocorticoid therapy and were followed for a median of 2 years. RESULTS All patients with PMR were deemed to respond to glucocorticoids clinically. A characteristic pattern of symmetrical, extracapsular inflammation, adjacent to greater trochanter, acetabulum, ischial tuberosity and/or symphysis pubis, was observed in 14/22 of the PMR cases. In PMR, this pattern was associated with complete glucocorticoid response (p=0.01), higher pretreatment C-reactive protein (CRP) and serum interleukin-6 (IL-6), and better post-treatment fatigue and function. Only 1/14 in the extracapsular group could stop glucocorticoids within 1 year, compared with 4/7 of the others. A score derived from the five sites discriminating best between PMR and RA correlated with IL-6 (p<0.002). IL-6 levels ≥16.8 pg/mL had 86% sensitivity and 86% specificity for the extracapsular MRI pattern. CONCLUSIONS A subset of patients with rheumatologist-diagnosed PMR had a characteristic, extracapsular pattern of MRI inflammation, associated with elevated IL-6/CRP and with complete patient-reported glucocorticoid responsiveness.
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Affiliation(s)
- Sarah Louise Mackie
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK
- NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | | | - Eiji Fukuba
- Department of Radiology, Shimane University, Izumo, Japan
| | - Emma Harris
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Paul Emery
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK
- NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Richard Hodgson
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK
- NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
- University of Manchester Centre for Imaging Sciences, Manchester, UK
| | - Jane Freeston
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK
- NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Dennis McGonagle
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK
- NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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50
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Duarte C, Ferreira RJDO, Mackie SL, Kirwan JR, Pereira da Silva JA. Outcome Measures in Polymyalgia Rheumatica. A Systematic Review. J Rheumatol 2015; 42:2503-11. [DOI: 10.3899/jrheum.150515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To identify the instruments used to assess polymyalgia rheumatica (PMR) in published studies.Methods.A systematic literature review of clinical trials and longitudinal observational studies related to PMR, published from 1970 to 2014, was carried out. All outcome and assessment instruments were extracted and categorized according to core areas and domains, as defined by the OMERACT (Outcome Measures in Rheumatology) Filter 2.0.Results.Thirty-five articles (3221 patients) were included: 12 randomized controlled trials (RCT); 3 nonrandomized trials; and 20 observational studies. More than 20 domains were identified, measured by 29 different instruments. The most frequently used measures were pain, morning stiffness, patient global assessment and physician global assessment, erythrocyte sedimentation rate, and C-reactive protein. The definition of outcomes varied considerably between studies.Conclusion.The outcome measures and instruments used in PMR are numerous and diversely defined. The establishment of a core set of validated and standardized outcome measurements is needed.
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