Is cancer associated with polymyalgia rheumatica?: A cohort study in the General Practice Research Database

Muller, Sara; Hider, Samantha L; Belcher, John; Helliwell, Toby; Mallen, Christian D

Abstract

OBJECTIVE: To investigate the incidence of new cancer diagnoses in a community sample of patients with polymyalgia rheumatica (PMR). METHODS: All incident cases of PMR in the UK General Practice Research Database (GPRD) (1987-99), without pre-existing cancer or vascular disease and treated with corticosteroids (n=2877) were matched with up to five age, sex and GP practice patients without PMR (n=9942). Participants were followed up until first cancer diagnosis, death, transfer out of the database or end of available records. RESULTS: The mean age of the sample was 71.6 years (SD 9.0), 73% were female. Median follow-up time was 7.8 years (IQR 3.4, 12.3). 667 (23.2%) people with a PMR diagnosis developed cancer compared with 1938 (19.5%) of those without PMR. There was an interaction between PMR status and time. In the first 6 months after diagnosis, those with a PMR diagnosis were significantly more likely to receive a cancer diagnosis (adjusted HR (95% CI): 1.69 (1.18 to 2.42)). The number of events was small, but occurrences of prostate, blood, lymph nodes, female reproductive and nervous system cancers may be more common in those with PMR in the first 6 months after PMR diagnosis. CONCLUSIONS: An increase in the rate of cancer diagnoses was noted in the first 6 months of observation, but we were unable to determine whether the cancer incidence in PMR was different from controls, beyond this time point. Clinicians should ensure they fully exclude cancer as a cause of PMR-like symptoms and monitor patients for possible malignancies.

Citation

Muller, S., Hider, S. L., Belcher, J., Helliwell, T., & Mallen, C. D. (2014). Is cancer associated with polymyalgia rheumatica?: A cohort study in the General Practice Research Database. Annals of the Rheumatic Diseases, 73(10), 1769 -1773. https://doi.org/10.1136/annrheumdis-2013-203465

• Journal Article Type: Article
• Acceptance Date: Jun 23, 2013
• Online Publication Date: Sep 4, 2014
• Publication Date: Jul 10, 2014
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 73
• Issue: 10
• Pages: 1769 -1773
• DOI: https://doi.org/10.1136/annrheumdis-2013-203465
• Keywords: Epidemiology, Health services research, polymyalgia Rheumatica, Aged, 80 and over, Cohort Studies, Databases, England, Family Practice, Female, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasms, Risk Factors, Wales
• Publisher URL: http://dx.doi.org/10.1136/annrheumdis-2013-203465