Long-term use of glucocorticoids for polymyalgia rheumatica: follow-up of the PMR Cohort Study

• Published in: Rheumatology advances in practice Vol. 6; no. 2; p. rkac034
• Main Authors: Muller, Sara, Hider, Samantha L, Singh Sokhal, Balamrit, Lawton, Sarah A, Helliwell, Toby, Mallen, Christian D
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 2022
• Subjects: Aged; Analysis; Care and treatment; Corticosteroids; Family medicine; Original; Pain; Surveys; United Kingdom; PMR; cohort studies; primary health care
• ISSN: 2514-1775; 2514-1775
• DOI: 10.1093/rap/rkac034

Abstract Objectives PMR is a common inflammatory condition in older adults, characterized by bilateral hip and shoulder pain and stiffness. Reducing oral glucocorticoids, classically used for ≤2 years, are the mainstay of treatment. This study considers the factors early in the disease course that might be associated with prolonged treatment. Methods Six hundred and fifty-two people with incident PMR were recruited from English general practices (2012–2014). Participants completed seven questionnaires over 2 years (used to allocate people to pain–stiffness trajectories) and a further long-term follow-up (LTFU) questionnaire a median of 5.16 years after diagnosis. Characteristics of those still taking and having ceased glucocorticoids were described and compared using Kruskal–Wallis and χ2 and Student’s 2-sample t-tests as appropriate. Results Of the 197 people completing the LTFUQ questionnaire, 179 people reported ever having taken glucocorticoids. Of these, 40.1% were still on treatment, with a median (quartile 1, quartile 3) daily dose of 5 (1.5, 9)  mg. People still taking glucocorticoids were more likely to be older (72.5 vs 70.2 years, P = 0.035), live alone (31.8 vs 15.0%, P = 0.01) and have self-managed their glucocorticoid dose (39.1 vs 11.0%, P < 0.0001). They were also more likely to belong to a pain–stiffness trajectory class with sustained symptoms. Conclusions PMR is not always a time-limited condition. Few patient characteristics are associated with prolonged treatment early in the disease course, but those who are older and who have sustained symptoms might be at greater risk. Although accurate prediction is not yet possible, clinicians should monitor people with PMR carefully to manage symptoms and reduce the cumulative glucocorticoid dose.