Background/Purpose: Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease of the shoulder and pelvic girdle. In the majority of centres, baseline shoulder radiograph forms part of the initial diagnostic workup. However, the prevalence of concomitant osteoarthritis (OA), and indeed its impact on disease and patient reported outcomes remains unknown.

Methods: 43 consecutive patients, fulfilling the provisional 2012 EULAR/ACR PMR classification criteria were recruited via a fast track PMR clinic. At the initial clinic visit, patients underwent a bilateral shoulder radiograph, and patient reported outcomes including fatigue using the Functional Assessment of Chronic Illness Therapy – Fatigue scale (FACIT-F), mood  using the Patient Health Questionnaire(PHQ-9), anxiety using the Generalised Anxiety Disorder Assessment (GAD-7), pain (visual analogue scale (VAS)), and overall health related quality of life and disability using the Health Assessment Questionnaire-Disability Index(HAQ-DI) were collected. Normally distributed continuous variables are expressed as means with standard deviations (SD). Continuous variables are compared using the independent t-test. Categorical variables are summarised by frequency and percentage (%) and compared using the chi-square test or Fishers exact test. The association between continuous variables and categorical variables are assessed using the Kruskal-Wallis test.  The statistical analysis was performed using STATA MP Version 18. P values < 0.05 are considered statistically significant.

Results: A total of 43 patients, including 21 (48.8%) females, were recruited. 29 (67.4%) patients had evidence of degenerative change of their acromioclavicular joints on shoulder radiograph. Notably, no patient had evidence of erosive change, or crystal arthropathy. The mean age in those with degenerative changes was 70.21 (SD 7.87), and 73.29 (SD 7.17) in those without.

There was a statistically significant higher pVAS  (p=0.0049) and HAQ pain score (p=0.0041) in those with degenerative changes. There was also a statistically significant lower FACIT-F score in those with evidence of degenerative change (p=0.0376). There was no statistically significant difference between HAQ-DI or HAQ- global patient scores between the groups. Notably, the frequency of disease relapse at one year was higher in those with degenerative change (62%) versus those without (42.8%).

Conclusion: This study, demonstrates the high prevalence of concomitant acromioclavicular joint OA in those with PMR, and for the first time highlights the impact that this has on patient reported pain and fatigue, and overall disease outcomes. This has potential implications for PMR disease management, and it is intended that this study will bring increased awareness to the importance of screening for and addressing OA management where present in those with PMR.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-concomitant-shoulder-osteoarthritis-in-polymyalgia-rheumatica/