Background/Purpose: Patients with polymyalgia rheumatica (PMR) are commonly diagnosed and cared for by non-rheumatology providers (i.e., primary care). Lack of access to specialty care can impact diagnosis and treatment. The aim of this study was to describe the clinical and sociodemographic factors associated with receiving specialty care in patients with a new diagnosis of PMR.

Methods: An inception cohort of patients with a new diagnosis of PMR was created using Medicare fee-for-service claims data from 2016-2022. Patients with PMR were included if they were age ≥50 years and had: 1) ≥1 inpatient or ≥2 outpatient claims with ICD-10-CM M35.3 ≥30 days and < 365 apart, 2) a prescription for glucocorticoids (GC) 7.5–30 mg/day filled within 30 days from 1st inpatient diagnosis, or filled between 1st outpatient diagnosis to 30 days after 2nd diagnosis, with a cumulative GC use of ≥200 mg over ≥120 days of first prescription period, 3) continuous enrollment ≥1 year prior to index date (first GC prescription) with no evidence for PMR or giant cell arteritis (GCA), 4) ≥1 year of continuous enrollment after index date. Exclusion criteria applied at baseline using all available prior data included GCA or any other rheumatologic conditions, except for seronegative rheumatoid arthritis. Sociodemographic and comorbidity data was collected at baseline. Other covariates of interest included: social vulnerability index, rural-urban commuting area, rheumatologist density per county, initial GC dose, and frailty, calculated using a validated claims-based frailty index. The outcome of interest was care from a rheumatology provider (≥1 visit) during the first year after PMR diagnosis. Univariate Poisson regression was performed to assess factors associated with access to rheumatology. In patients with two-year follow-up, we assessed continued rheumatology visits, including ongoing rheumatology care, defined as ≥2 rheumatology visits per year during each of the 2 years after PMR diagnosis.

Results: A total of 20,536 patients with new-onset PMR were included (Table 1). During the first year of follow-up, 11,965 (58.3%) patients received care from a rheumatology provider. Of these, 3,907 (32.7%) were seen by a rheumatologist after initiation of GC treatment (i.e., inclusion in cohort), with median (IQR) time to first rheumatology visit of 57 (25, 135) days. In univariate analysis, older age, non-northeast US region, non-urban areas, lower rheumatologist density, frailty, and higher comorbidity burden were associated with a lower likelihood of seeing rheumatology during the first year (Table 2). Patients started on GC doses either lower or higher than recommended by current guidelines were also less likely to see rheumatology during the first year. Of 16,098 patients with continuous two-year follow-up, only half who saw rheumatology during the first year remained under continuous rheumatology care (Table 3).

Conclusion: In the U.S., over half of patients newly diagnosed with PMR see a rheumatologist within the first year. However, patients at higher risk for GC toxicity (older, frail, high multimorbidity) are less likely to receive rheumatology care, highlighting the need to improve PMR referral practices.

Table 1. Characteristics of patients with new onset Polymyalgia Rheumatica with and without a rheumatology visit during the first-year of follow-up

Table 2. Factors associated with access to any rheumatology care during first-year of follow-up

Table 3. Access to rheumatology in patients with PMR at 2-year follow-up (n = 16,098)*

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/access-to-rheumatology-care-in-patients-with-new-diagnosis-of-polymyalgia-rheumatica-analysis-from-a-national-inception-cohort/