Predictors of complete 24-month remission and flare in patients with polymyalgia rheumatica

To date, few papers investigated the predictive factors of sustained 24-month remission and of flare in patients with polymyalgia rheumatica (PMR). We retrospectively evaluated clinical charts from PMR patients. Patients were evaluated at baseline, at 1 month, 3 months and subsequently at 6, 12 and 24 months. We analyzed the differences between patients who achieved remission within 6 months of diagnosis, those who achieved remission at 24 months, and patients who did not. Among 137 patients, 57 (41.6%) achieved remission at 6 months and complete remission at 24 months was achieved by 104 patients (75.9%). The erythrocyte sedimentation rate at baseline was higher in patients who did not achieve remission than in patients who achieved it (p = 0.012). Female patients were less likely to achieve complete remission (45/68, 66.2% vs. 59/69, 85.5%, p = 0.01) compared to males. Fifty-four patients (39.4%) experienced at least one flare. Patients who did not achieve sustained complete remission suffered a flare more often (22/39 vs. 32/98, p = 0.01) and earlier than patients who did (10.33 ± 7.89 months vs. 13.64 ± 6.97 months, p = 0.011). Multivariate analysis confirmed that female sex (RR = 3.2, 95% CI 1.3-7.9) and higher baseline prednisone dosage (RR = 1.1, 95% CI 1.007-1.109) were negative independent predictors of complete remission at 24 months. A significant percentage of patients with PMR requires prolonged steroid treatment and may experience flares at 24 months of follow-up. Female sex and higher baseline prednisone dosage are negative independent predictors of complete remission at 24 months.

[Giant cell arteritis diagnosed by a temporal artery biopsy without abnormal imaging and physical findings in an elderly patient presenting with fever]

Giant cell arteritis (GCA) is considered in the differential diagnosis of fever of unknown origin in the elderly. We describe the case of an 83-year-old man with GCA diagnosed by temporal artery biopsy (TBA), who did not exhibit abnormal physical and imaging findings. The patient had fever and elevated C-reactive protein (CRP), which had persisted for two months. He was examined and treated with antibiotics and antipyretic analgesics in a local clinic, but they had little effect. He was referred to us. He showed no abnormal physical findings. Image examinations, including ultrasonography, CT, MRI, and PET-CT, showed no abnormal findings. We performed TBA. The histological examination of the artery showed inflammatory cell invasion and rupture of the internal elastic membrane, indicating GCA. We initiated oral corticosteroid treatment. The patient's fever quickly disappeared and his CRP level returned to normal. TBA has been the gold standard for the diagnosis of GCA. However, TBA is an invasive procedure and the sensitivity depends on the operator's skill level. Recently, imaging examinations have frequently been used for the diagnosis of GCA. The sensitivity of imaging examinations is similar to that of TBA. However, our case did not show any abnormal imaging findings and was only diagnosed by TBA. This case suggested that TBA remains a useful examination for elderly patients with fever that persists for a long time.

[Glucocorticoid sensitive bilateral leg swelling in an 85-year-old woman presenting with polymyalgia rheumatica: A case report]

INTRODUCTION

Polymyalgia rheumatica (PMR) can be associated with distal swelling indicating an associated RS3PE syndrome. We report a case of PMR associated with oedema of the lower limbs, which resolved rapidly under glucocorticoid therapy.

CASE REPORT

A 85-year-old woman presented with a 4 month history of PMR responding to the 2012 EULAR/ACR classification criteria. Examination of the lower limbs revealed pitting oedema bilaterally up to the knees, with mild erythema and warmth. Hypoalbuminemia (30g/L) was present. There was no cardiac, renal or hepatic cause to explain leg swelling. FDG-PET/CT demonstrated increased metabolism in the periarticular area of shoulders and hips. There was no sign of aortitis or neoplasia. Under treatment with prednisone 10mg/day leg swelling disappeared concomitantly to a weight loss of 8kg within 8days.

CONCLUSION

This case, the first to report leg swelling of inflammatory origin in the context of PMR, could indicate an increased vascular permeability caused by inflammation in the elderly.

Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015

OBJECTIVE

There are no estimates of the prevalence of giant cell arteritis (GCA) or polymyalgia rheumatica (PMR) in a US population in the current millennium. The purpose of this study was to estimate the 2015 prevalence of GCA and PMR in a US population-based setting.

METHODS

Cohorts of incident GCA in 1950-2009 and incident PMR in 1970-2014 were previously identified among residents of Olmsted County, Minnesota. Prevalence estimates were obtained from the age-, sex-, and calendar year-specific incidence rates and adjusted to the US white 2010 population aged ≥50 years. Confidence intervals (CI) were computed using bootstrap sampling.

RESULTS

There were 248 incident cases of GCA in 1950-2009 and 790 cases of PMR in 1970-2014. The overall age- and sex-adjusted prevalence rate of GCA on January 1, 2015 was 204 (95% CI: 161-254) per 100,000 population aged ≥50 years. GCA prevalence rate in women was 304 (95% CI: 229-375) and in men was 91 (95% CI: 46-156) per 100,000 population. The overall age and sex adjusted prevalence rate of PMR on January 1, 2015 was 701 (95% CI: 651-750) per 100,000 population. PMR prevalence rate in women was 870 (95% CI: 787-957) and in men was 508 (95% CI: 426-589) per 100,000 population.

CONCLUSION

Prevalence rates of GCA and PMR in 2015 are similar to previously published prevalence estimates in the late 1990s. The health burden of these diseases among older persons continues to be substantial and reflects the need for continued efforts to better manage it.