Skip to main content

Research Repository

Advanced Search

Challenges of diagnosing and managing polymyalgia rheumatica: a multi-methods study in UK general practice

Hider, Samantha; Lawton, Sarah; Muller, Sara; Helliwell, Toby; Zwierska, Irena; Mallen, Christian; Richardson, Jane

Authors

Irena Zwierska

Jane Richardson



Abstract

BACKGROUND: Polymyalgia rheumatica (PMR) is one of the most common inflammatory arthritic disorders seen in older individuals. Most patients with PMR are diagnosed and managed exclusively in general practice, yet primary care-focused research is lacking. AIM: To identify and explore the challenges of diagnosis and management of PMR in general practice. DESIGN AND SETTING: A multi-methods study in UK primary care. METHOD: The multi-methods study comprised two complementary studies: a national questionnaire survey of 5000 randomly selected GPs from across the UK; and a qualitative semi-structured telephone interview study of UK GPs. Simple descriptive statistics were used to analyse questionnaire data. A thematic approach was used to analyse verbatim transcripts of the GP interviews. RESULTS: In total, 1249 (25%) GPs responded to the questionnaire survey. From this total, 24 GPs were interviewed for the qualitative study. Features used by GPs to identify PMR were largely in line with current guidance. Diagnosis was found to be challenging, with GPs relying heavily on response to treatment with glucocorticoids. Investigations advised by current British PMR guidance to attempt to rule out other causes for symptoms were not routinely requested. Concerns surrounding ongoing treatment with glucocorticoids were widespread in relation to both potential adverse effects and ongoing monitoring. CONCLUSION: Focused strategies to investigate and therefore exclude non-PMR differential diagnoses are required for patients with new-onset suspected PMR symptoms. Additionally, ongoing active review for alternative causes for symptoms as well as vigilance for treatment complications needs to be implemented.

Citation

Hider, S., Lawton, S., Muller, S., Helliwell, T., Zwierska, I., Mallen, C., & Richardson, J. (2018). Challenges of diagnosing and managing polymyalgia rheumatica: a multi-methods study in UK general practice. British Journal of General Practice (BJGP), 68(676), E783-E793. https://doi.org/10.3399/bjgp18X699557

Journal Article Type Article
Acceptance Date Jun 3, 2018
Online Publication Date Oct 25, 2018
Publication Date 2018-11
Journal BRITISH JOURNAL OF GENERAL PRACTICE
Print ISSN 0960-1643
Publisher Royal College of General Practitioners
Volume 68
Issue 676
Pages E783-E793
DOI https://doi.org/10.3399/bjgp18X699557
Keywords diagnosis; general practice; glucocorticoids; physicians, family; polymyalgia rheumatica; treatment
Public URL https://keele-repository.worktribe.com/output/427054
PMID 30348883