Background/Purpose: Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA) are systemic inflammatory disorders treated with prolonged corticosteroid therapy. Prolonged use of corticosteroids is a significant risk factor for the development of osteoporosis and subsequent fractures and also an increased risk of infections.^{1, 2, 3}  Our previous retrospective studies revealed that the rate of steroid discontinuation in PMR patients was notably low, with only 17% ceasing steroid use after one year, increasing to only an average of 31% after two years.^4,5 Osteoporosis screening and vaccinations are universal recommendations to enhance the healthcare outcomes in these patients. We analyzed the data from a cohort of PMR patients at a single academic medical center to assess the rate of osteoporosis screening and routine vaccinations.

Methods: We conducted a retrospective review of PMR patients at a rheumatology clinic, focusing on those diagnosed with PMR or PMR with GCA, and excluded patients with other rheumatological disorders. The study included 459 patients from 2011 to 2021.

Results: The patient cohort had a mean age of 71.6 years, predominantly female (1.3:1 ratio). The initial mean prednisone dose was 23.4 mg, tapering to 2.2 mg by the fifth year. After one year, 81.6% of patients remained on steroids; this number decreased to 21% by year five. Screening for osteoporosis with DXA scans was performed in 64.4% of patients; 37.3% of the total PMR patients were diagnosed with osteoporosis, and 16% had osteopenia. The majority of osteoporosis diagnoses occurred after PMR diagnosis, and 29.8% of these patients experienced fragility fractures. Only 67.6% of the osteoporosis patients received treatment for osteoporosis, primarily with bisphosphonates. Vaccination rates were suboptimal, with less than 80% receiving the flu vaccine and lower rates for other vaccines.

Conclusion: This study highlights a concerning pattern of prolonged steroid use among PMR patients, with a significant number remaining on steroids after five years. The screening for osteoporosis and vaccination rates were less than optimal, indicating improved clinical management strategies were needed. Additionally, close to one-third of the patients diagnosed with osteoporosis did not receive any treatment. The study’s retrospective nature and potential missing data from external facilities are limitations to consider.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/challenges-in-managing-polymyalgia-rheumatica-and-giant-cell-arteritis-steroid-dependence-and-preventive-care/