Clinical Research
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Polimyaljia romatika hastalarının klinik izlemi: Tek merkezli, retrospektif kohort çalışması

Year 2022, Volume: 5 Issue: 3, 181 - 187, 15.10.2022
https://doi.org/10.53446/actamednicomedia.1109338

Abstract

Bu çalışmada izole polimyaljia romatika (PMR) tanılı hastaların demografik, klinik durum, laboratuvar bulguları, hastalık seyri ve tedavi yanıtlarının kısa dönem verilerinin taranması ve kortizon başlangıç dozunun ve idame tedavi rejimlerinin, klinik ve laboratuvar progresyonuna etkisinin incelenmesi amaçlanmıştır. Çalışmada 2001-2020 yılları arasında takip edilen toplam 39 PMR hastasının dosyaları tarandı. Eşlik eden temporal arteriti ve kanseri olan hastalar ise çalışmadan dışlanarak toplam 19 hasta (K:16, E:3) çalışmaya dahil edildi. Hastaların demografik verileri, antropometrik ölçümleri, ek hastalıkları, geliş şikayetleri, fizik muayene bulguları, klinik bulguları, laboratuvar bulguları (akut faz yanıtları), tedavileri, tedavi değişiklikleri, kümülatif kortizon dozları kaydedildi. Hastaların 1. ay, 4. ay ve 7. ay poliklinik kontrollerinde elde edilen medikal kayıtları bir olgu formu yardımı ile not edildi. Hastaların yaş ortalamaları 68±8 yıl iken ortalama kortizon başlangıç dozu 21,5±8,9 mg idi. Birinci poliklinik kontrolünde, hastaların %52,6’sının (n=10) şikayetleri tamamen gerilerken, bu oran 2. ve 3. poliklinik kontrolünde sırası ile %47,4 (n=9) ve %73,7 (n=14) idi. Birinci poliklinik kontrolü ortalama eritrosit sedimentasyon hızı (ESH) ve C-reaktif protein (CRP) değerleri sırası ile 21,7±12,3 mm/saat ve 5,8±5,1 mg/dl idi. İkinci ve 3. poliklinik kontrolünde ortalama ESH değerleri sırası ile 36,5±27,3 mm/saat ve 27,3±18,6 mm/saat iken ortalama CRP değerleri sırası ile 27,2±43,0 mg/dl ve 17,6±30,2 mg/dl idi. Hastaların takipleri sırasındaki remisyon oranları ise 2. poliklinik kontrolünde %47,4 (n=9) ve 3. poliklinik kontrolünde%31,6 (n=6) olarak bulundu. Sonuç olarak, çalışmamızda klinik özellikler ve başlangıç kortizon dozları literatürle uyumlu bulundu. Remisyon oranımız düşük saptandı ve bu durum hastaların tedaviye uyumsuz olmaları ile ilişkilendirildi.

References

  • Hunder GG. The early history of giant cell arteritis and polymyalgia rheumatica: first descriptions to 1970. Mayo Clin Proc. 2006;81(8):1071-1083. doi:10.4065/81.8.1071
  • Gonzalez-Gay MA. Giant cell arteritis and polymyalgia rheumatica: two different but often overlapping conditions. Semin Arthritis Rheum. 2004;33(5):289-293. doi:10.1016/j.semarthrit.2003.09.007
  • Partington RJ, Muller S, Helliwell T, Mallen CD, Abdul Sultan A. Incidence, prevalence and treatment burden of polymyalgia rheumatica in the UK over two decades: a population-based study. Ann Rheum Dis. 2018;77(12):1750-1756. doi:10.1136/annrheumdis-2018-213883
  • González-Gay MA, Matteson EL, Castañeda S. Polymyalgia rheumatica. Lancet. 2017;390(10103):1700-1712. doi:10.1016/S0140-6736(17)31825-1
  • Masson C, Gonzalez-Gay MA. Polymyalgia rheumatica and giant cell arteritis. In: Bijlsma JWJ, Hachulla E, eds. EULAR Textbook on Rheumatic Diseases. 2nd ed. London, UK: BMJ Publishing Group; 2015:754–778.
  • Salvarani C, Cantini F, Macchioni P, et al. Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum. 1998;41(7):1221-1226. doi:10.1002/1529-0131(199807)41:7<1221::AID-ART12>3.0.CO;2-W
  • Cantini F, Salvarani C, Olivieri I, et al. Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: a prospective follow-up study. Semin Arthritis Rheum. 2000;30(1):17-24. doi:10.1053/sarh.2000.8366
  • 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(10):1799-1807. doi:10.1136/annrheumdis-2015-207492
  • Yates M, Watts RA, Swords F, MacGregor AJ. Glucocorticoid withdrawal in polymyalgia rheumatica: the theory versus the practice. Clin Exp Rheumatol. 2017;35(1):1-2.
  • Gonzalez-Gay MA, Agudo M, Martinez-Dubois C, Pompei O, Blanco R. Medical management of polymyalgia rheumatica. Expert Opin Pharmacother. 2010;11(7):1077-1087. doi:10.1517/14656561003724739
  • Yağcı İ. Polymyalgia Rheumatica in 21st Century. Turk J Phys Med Rehab 2012;58:143-150. doi:10.4274/tftr.70298
  • Charpentier A, Verhoeven F, Sondag M, Guillot X, Prati C, Wendling D. Therapeutic response to prednisone in relation to age in polymyalgia rheumatica: a comparison study. Clin Rheumatol. 2018;37(3):819-823. doi:10.1007/s10067-018-3988-3
  • Dejaco C, Duftner C, Cimmino MA, et al. Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus. Ann Rheum Dis. 2011;70(3):447-453. doi:10.1136/ard.2010.133850
  • Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE. Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol. 2005;32(1):65-73.
  • Chuang TY, Hunder GG, Ilstrup DM, Kurland LT. Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. Ann Intern Med. 1982;97(5):672-680. doi:10.7326/0003-4819-97-5-672
  • Bowness P, Shotliff K, Middlemiss A, Myles AB. Prevalence of hypothyroidism in patients with polymyalgia rheumatica and giant cell arteritis. Br J Rheumatol. 1991;30(5):349-351. doi:10.1093/rheumatology/30.5.349
  • Juchet H, Labarthe MP, Ollier S, Vilain C, Arlet P. Prevalence of hypothyroidism and hyperthyroidism in temporal arteritis and rhizomelic pseudopolyarthritis. A controlled study of 104 cases. Rev Rhum Ed Fr. 1993;60(7-8):493-498.
  • Partington R, Helliwell T, Muller S, Abdul Sultan A, Mallen C. Comorbidities in polymyalgia rheumatica: a systematic review. Arthritis Res Ther. 2018;20(1):258. Published 2018 Nov 20. doi:10.1186/s13075-018-1757-y
  • Van Hemelen M, Betrains A, Vanderschueren S, Blockmans D. Impact of age at diagnosis in polymyalgia rheumatica: A retrospective cohort study of 218 patients. Autoimmun Rev. 2020;19(12):102692. doi:10.1016/j.autrev.2020.102692
  • Lee JH, Choi ST, Kim JS, et al. Clinical characteristics and prognostic factors for relapse in patients with polymyalgia rheumatica (PMR). Rheumatol Int. 2013;33(6):1475-1480. doi:10.1007/s00296-012-2580-4
  • Cimmino MA, Parodi M, Montecucco C, Caporali R. The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity. BMC Musculoskelet Disord. 2011;12(1):94. Published 2011 May 14. doi:10.1186/1471-2474-12-94
  • Caporali R, Cimmino MA, Ferraccioli G, et al. Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2004;141(7):493-500. doi:10.7326/0003-4819-141-7-200410050-00005
  • Aoki A, Kobayashi H, Yamaguchi Y. Predictors of long-term therapy with glucocorticoid in polymyalgia rheumatica. Mod Rheumatol. 2021;31(2):417-420. doi:10.1080/14397595.2020.1777680
  • Diamantopoulos AP, Hetland H, Myklebust G. Leflunomide as a corticosteroid-sparing agent in giant cell arteritis and polymyalgia rheumatica: a case series. Biomed Res Int. 2013;2013:120638. doi:10.1155/2013/120638
  • Helliwell T, Hider SL, Mallen CD. Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice. Br J Gen Pract. 2013;63(610):e361-e366. doi:10.3399/bjgp13X667231
  • Yurdakul FD, Bodur H, Sivas F, Başkan B, Eser F, Yılmaz O. Clinical Features, Treatment and Monitoring in Patients With Polymyalgia Rheumatica. Arch Rheumatol 2015;30(1):28-33. doi:10.5606/ArchRheumatol.2015.4643

Isolated polymyalgia rheumatica: a cross-sectional, single-center, retrospective cohort study

Year 2022, Volume: 5 Issue: 3, 181 - 187, 15.10.2022
https://doi.org/10.53446/actamednicomedia.1109338

Abstract

Aim: The aim of the study was to review sociodemographic variables, clinical and laboratory findings, disease progression and treatment response of patients with isolated polymyalgia rheumatica and to investigate the effect of initial steroid dose and maintenance treatment on the progression of clinical and laboratory outcome.
Material and Method: The medical records of 39 polymyalgia rheumatic patients who followed up between 2001 and 2020 were screened. After excluding patients with overlapped giant cell arteritis and malignancies, 19 polymyalgia rheumatica patients (female:16 and male:3) were included in the study. Demographic data, anthropometric measurements, comorbidities, initial symptom, physical examination, clinical and laboratory (acute phase reactants) findings, medications, changes in treatment status, and cumulative steroid dose were recorded. The medical data of first (1st month), second (4th month), and third (7th month) visits were noted according to the structured form.
Results: The mean age was 68±8 years and the mean initial steroid dose was 21.5±8.9 mg. While the complaints regarding polymyalgia rheumatica decreased in 52.6% of patients (n=10) in the first visit, those complaints regressed in 47.4% (n=9) and 73.7% (n=14) of patients in the second and third visit, respectively. In the first visit (1st month), the mean erythrocyte sedimentation rate and C-reactive protein values were 21.7±12.3 mm/h and 5.8±5.1 mg/dl. In the second (4th month) and third visits (7th month), while the mean erythrocyte sedimentation rate was found as 36.5±27.3 mm/h and 27.3±18.6 mm/h, the mean C-reactive protein was 27.2±43.0 mg/dl and 17.6±30.2 mg/dl, respectively. Clinical remission was observed in 47.4% of patients (n=9) in the second visit and in 31.6% of patients (n=6) in the third visit. Median cumulative corticosteroid doses were 600 mg in first visit, 960 mg in second visit, and 1346 mg in the third visit.
Conclusion: The clinical characteristics and the initial steroid dose were compatible with the literature. Even though cumulative corticosteroid doses were quite high, lower remission rates were observed in these patients. The possible reason for this was considered to be the non-adherence of the patients to the treatment.

References

  • Hunder GG. The early history of giant cell arteritis and polymyalgia rheumatica: first descriptions to 1970. Mayo Clin Proc. 2006;81(8):1071-1083. doi:10.4065/81.8.1071
  • Gonzalez-Gay MA. Giant cell arteritis and polymyalgia rheumatica: two different but often overlapping conditions. Semin Arthritis Rheum. 2004;33(5):289-293. doi:10.1016/j.semarthrit.2003.09.007
  • Partington RJ, Muller S, Helliwell T, Mallen CD, Abdul Sultan A. Incidence, prevalence and treatment burden of polymyalgia rheumatica in the UK over two decades: a population-based study. Ann Rheum Dis. 2018;77(12):1750-1756. doi:10.1136/annrheumdis-2018-213883
  • González-Gay MA, Matteson EL, Castañeda S. Polymyalgia rheumatica. Lancet. 2017;390(10103):1700-1712. doi:10.1016/S0140-6736(17)31825-1
  • Masson C, Gonzalez-Gay MA. Polymyalgia rheumatica and giant cell arteritis. In: Bijlsma JWJ, Hachulla E, eds. EULAR Textbook on Rheumatic Diseases. 2nd ed. London, UK: BMJ Publishing Group; 2015:754–778.
  • Salvarani C, Cantini F, Macchioni P, et al. Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum. 1998;41(7):1221-1226. doi:10.1002/1529-0131(199807)41:7<1221::AID-ART12>3.0.CO;2-W
  • Cantini F, Salvarani C, Olivieri I, et al. Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: a prospective follow-up study. Semin Arthritis Rheum. 2000;30(1):17-24. doi:10.1053/sarh.2000.8366
  • 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(10):1799-1807. doi:10.1136/annrheumdis-2015-207492
  • Yates M, Watts RA, Swords F, MacGregor AJ. Glucocorticoid withdrawal in polymyalgia rheumatica: the theory versus the practice. Clin Exp Rheumatol. 2017;35(1):1-2.
  • Gonzalez-Gay MA, Agudo M, Martinez-Dubois C, Pompei O, Blanco R. Medical management of polymyalgia rheumatica. Expert Opin Pharmacother. 2010;11(7):1077-1087. doi:10.1517/14656561003724739
  • Yağcı İ. Polymyalgia Rheumatica in 21st Century. Turk J Phys Med Rehab 2012;58:143-150. doi:10.4274/tftr.70298
  • Charpentier A, Verhoeven F, Sondag M, Guillot X, Prati C, Wendling D. Therapeutic response to prednisone in relation to age in polymyalgia rheumatica: a comparison study. Clin Rheumatol. 2018;37(3):819-823. doi:10.1007/s10067-018-3988-3
  • Dejaco C, Duftner C, Cimmino MA, et al. Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus. Ann Rheum Dis. 2011;70(3):447-453. doi:10.1136/ard.2010.133850
  • Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE. Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol. 2005;32(1):65-73.
  • Chuang TY, Hunder GG, Ilstrup DM, Kurland LT. Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. Ann Intern Med. 1982;97(5):672-680. doi:10.7326/0003-4819-97-5-672
  • Bowness P, Shotliff K, Middlemiss A, Myles AB. Prevalence of hypothyroidism in patients with polymyalgia rheumatica and giant cell arteritis. Br J Rheumatol. 1991;30(5):349-351. doi:10.1093/rheumatology/30.5.349
  • Juchet H, Labarthe MP, Ollier S, Vilain C, Arlet P. Prevalence of hypothyroidism and hyperthyroidism in temporal arteritis and rhizomelic pseudopolyarthritis. A controlled study of 104 cases. Rev Rhum Ed Fr. 1993;60(7-8):493-498.
  • Partington R, Helliwell T, Muller S, Abdul Sultan A, Mallen C. Comorbidities in polymyalgia rheumatica: a systematic review. Arthritis Res Ther. 2018;20(1):258. Published 2018 Nov 20. doi:10.1186/s13075-018-1757-y
  • Van Hemelen M, Betrains A, Vanderschueren S, Blockmans D. Impact of age at diagnosis in polymyalgia rheumatica: A retrospective cohort study of 218 patients. Autoimmun Rev. 2020;19(12):102692. doi:10.1016/j.autrev.2020.102692
  • Lee JH, Choi ST, Kim JS, et al. Clinical characteristics and prognostic factors for relapse in patients with polymyalgia rheumatica (PMR). Rheumatol Int. 2013;33(6):1475-1480. doi:10.1007/s00296-012-2580-4
  • Cimmino MA, Parodi M, Montecucco C, Caporali R. The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity. BMC Musculoskelet Disord. 2011;12(1):94. Published 2011 May 14. doi:10.1186/1471-2474-12-94
  • Caporali R, Cimmino MA, Ferraccioli G, et al. Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2004;141(7):493-500. doi:10.7326/0003-4819-141-7-200410050-00005
  • Aoki A, Kobayashi H, Yamaguchi Y. Predictors of long-term therapy with glucocorticoid in polymyalgia rheumatica. Mod Rheumatol. 2021;31(2):417-420. doi:10.1080/14397595.2020.1777680
  • Diamantopoulos AP, Hetland H, Myklebust G. Leflunomide as a corticosteroid-sparing agent in giant cell arteritis and polymyalgia rheumatica: a case series. Biomed Res Int. 2013;2013:120638. doi:10.1155/2013/120638
  • Helliwell T, Hider SL, Mallen CD. Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice. Br J Gen Pract. 2013;63(610):e361-e366. doi:10.3399/bjgp13X667231
  • Yurdakul FD, Bodur H, Sivas F, Başkan B, Eser F, Yılmaz O. Clinical Features, Treatment and Monitoring in Patients With Polymyalgia Rheumatica. Arch Rheumatol 2015;30(1):28-33. doi:10.5606/ArchRheumatol.2015.4643
There are 26 citations in total.

Details

Primary Language English
Subjects Rheumatology and Arthritis
Journal Section Research Articles
Authors

Fatma Tuncer Kuru 0000-0002-1097-9991

Neslihan Gökçen 0000-0003-3022-493X

Ayten Yazıcı 0000-0003-2167-4509

Ayşe Çefle 0000-0002-3273-7969

Publication Date October 15, 2022
Submission Date April 26, 2022
Acceptance Date August 25, 2022
Published in Issue Year 2022 Volume: 5 Issue: 3

Cite

AMA Tuncer Kuru F, Gökçen N, Yazıcı A, Çefle A. Isolated polymyalgia rheumatica: a cross-sectional, single-center, retrospective cohort study. Acta Med Nicomedia. October 2022;5(3):181-187. doi:10.53446/actamednicomedia.1109338

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