RESEARCH - Can the prognosis of polymyalgia rheumatica be predicted at disease onset?

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Rheumatology Advance Access published online on January 11, 2010

Rheumatology, doi:10.1093/rheumatology/kep395

Can the prognosis of polymyalgia rheumatica be predicted at disease

onset? Results from a 5-year prospective study

L. Mackie1, M. A. Hensor1, Glenn Haugeberg2,3, Bipin

Bhakta1 and Colin T. Pease4

1NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute

of Molecular Medicine, University of Leeds, Leeds, UK, 2Division of

Rheumatology, Norwegian University of Science and Technology and

3Department of Rheumatology, Sørlandet Hospital, Kristiansand, Norway

and 4Department of Rheumatology, Leeds Teaching Hospitals NHS Trust,

Leeds, UK.

Abstract

Objective. To identify the features of PMR that may predict the

duration of steroid therapy, the occurrence of relapses and the late

development of GCA.

Methods. Prospective cohort study of 176 patients with PMR, followed

up for 5 years. Baseline factors associated with the duration of

steroids therapy were identified using regression. Predictors of

relapse and the late development of GCA were identified using binary

logistic regression.

Results. A total of 176 patients with PMR were included, of whom 124

stopped steroids within 5 years. The probability of stopping steroids

within 5 years was independently reduced by an elevated plasma

viscosity (PV) [hazard ratio (HR) = 0.49; 95% CI 0.29, 0.82 for a PV

2.00 mPa s compared with a PV 1.80 mPa s; overall P = 0.024] and by

starting treatment at >15 mg prednisolone (HR = 0.63; 95% CI 0.41,

0.97; P = 0.036). Either of these independently reduced the chances of

stopping steroids within a given time interval between 27 and 51%. No

significant predictors of relapse were identified. Predictors of late

GCA on univariable analysis were female sex [odds ratio (OR) = 8.16;

95% CI 1.06, 63.13; P = 0.044], HLA-DRB1*0101 or -*0401 alleles (OR =

4.95; 95% CI 1.05, 23.34; P = 0.043), PV 2.00 mPa s compared with PV

1.80 mPa s (OR = 10.64; 95% CI 1.28, 88.38; P = 0.029) and initial

prednisolone dose >15 mg (OR = 4.53; 95% CI 1.61, 12.79; P = 0.004).

Conclusion. A higher PV in PMR increases the risk of prolonged steroid

therapy and late GCA. Female sex and particular HLA alleles may

increase the risk of late GCA. Starting patients on >15 mg

prednisolone is associated with a prolonged steroid duration.

Not an MD