Background/Purpose: Polymyalgia rheumatica (PMR) is a chronic inflammatory disease in which patients respond well to glucocorticoids (GCs). However, a number of patients experience a flare in the course of tapering GCs. We aimed to elucidate the negative factors that hinder the early clinical response in PMR patients.

Methods: Electronic medical records of 85 PMR patients between Jan 2011 and Dec 2017 were reviewed in second and tertiary centers. We analyzed the clinical and laboratory data at diagnosis (baseline), then at follow-up visits of these subjects. The tapering schedule of GC was determined by the attending rheumatologist. Patients were classified into subjects with a good versus poor clinical response mainly based on the daily GC (prednisolone or its equivalent) dose at the end of the year. Logistic regression analysis was performed to assess the factors related to an unfavorable response in our subjects.

Results: The mean age of PMR patients was 70.7 years with mean disease duration of 38.9 months, and 60% patients (51/85) were females. The mean dose of daily GC at the end of the year was 5.7 mg; 61.2% of patients tapered GC to less than 5 mg/day. The patients with hip pain or restricted range of hip motion at diagnosis showed a good clinical response (p = 0.002). In contrast, the presence of peripheral arthritis at diagnosis was associated with a poor clinical response to GCs (p = 0.002). A multivariable logistic regression analysis revealed that absence of hip involvement [hazard ratio (HR); 0.179, 95% confidence interval (CI); 0.053-0.600, p = 0.005], presence of peripheral arthritis [HR; 4.099 (1.412-11.900), p = 0.009] and concurrent diabetes mellitus (HR; 3.524, 95% CI; 1.064-11.672, p = 0.039) at diagnosis were independently associated with a poor clinical response during the first year of treatment.

Conclusion: Our study demonstrates that PMR patients with peripheral arthritis or diabetes mellitus, and those without hip involvement are prone to a poor first-year clinical response to treatment.

References

1. Albrecht K, Huscher D, Buttgereit F, et al. Long termglucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database. Rheumatol Int. 2018; 38: 569–577.

2. Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2015; 74: 1799-807. 

ACR Meeting Abstracts - https://acrabstracts.org/abstract/detrimental-factors-affecting-the-first-year-clinical-response-in-korean-patients-with-polymyalgia-rheumatica/