Long-term use of glucocorticoids for polymyalgia rheumatica: follow-up of the PMR Cohort Study

Muller, Sara; Hider, Samantha L; Sokhal, Balamrit Singh; Lawton, Sarah A; Helliwell, Toby; Mallen, Christian D

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 chi(2) 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.

Citation

Muller, S., Hider, S. L., Sokhal, B. S., Lawton, S. A., Helliwell, T., & Mallen, C. D. (2022). Long-term use of glucocorticoids for polymyalgia rheumatica: follow-up of the PMR Cohort Study. Rheumatology Advances in Practice, 6(2), Article rkac034. https://doi.org/10.1093/rap/rkac034

• Journal Article Type: Article
• Acceptance Date: Apr 11, 2022
• Publication Date: May 11, 2022
• Journal: Rheumatology Advances in Practice
• Print ISSN: 2514-1775
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 6
• Issue: 2
• Article Number: rkac034
• DOI: https://doi.org/10.1093/rap/rkac034
• Keywords: PMR, cohort studies, primary health care
• Publisher URL: https://doi.org/10.1093/rap/rkac034