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2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative

Published on Oct 1, 2015in Annals of the Rheumatic Diseases14.299
· DOI :10.1136/annrheumdis-2015-207492
Christian Dejaco27
Estimated H-index: 27
(Medical University of Graz),
Yogesh P. Singh3
Estimated H-index: 3
(Southend University Hospital NHS Foundation Trust)
+ 43 AuthorsBhaskar Dasgupta35
Estimated H-index: 35
(Southend University Hospital NHS Foundation Trust)
Sources
Abstract
Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.
  • References (74)
  • Citations (65)
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References74
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#1Christian Dejaco (University of Graz)H-Index: 27
#2Yogesh P. SinghH-Index: 3
Last. Bhaskar DasguptaH-Index: 35
view all 8 authors...
To summarise evidence on therapeutic interventions and prognostic factors in polymyalgia rheumatica (PMR). A systematic literature review was conducted using Ovid Medline, Embase, PubMed, CINAHL, Web of Science and the Cochrane Library (1970 through April 2014). Quality of evidence (QoE) of identified studies was appraised by Grading of Recommendations Assessment, Development and Evaluation (GRADE) (interventions) and the Quality In Prognosis Studies (QUIPS) methodologies (prognostic factors). O...
26 CitationsSource
Background Since the description of the efficacy of rituximab (RTX) in treating patients with rheumatoid arthritis (RA), the use of this drug has been extended. However it is not clearly established the patient profile in which the administration of RTX may show greater benefit. Objectives To systematically review the published evidence to date regarding on the difference in efficacy in the treatment of RA with RTX in patients with rheumatoid factor (RF) positive and negative. Methods A sensitiv...
303 CitationsSource
#1Sofia Ramiro (UvA: University of Amsterdam)H-Index: 27
Last. Robert Landewé (UvA: University of Amsterdam)H-Index: 95
view all 9 authors...
Objectives To update the evidence for the safety of synthetic disease-modifying antirheumatic drugs (sDMARDs), glucocorticoids (GC) and biological DMARDs (bDMARDs) in patients with rheumatoid arthritis (RA) to inform the European League Against Rheumatism (EULAR) recommendations for the management of RA. Methods Systematic literature review (SLR) of observational studies (including registries). Interventions were any bDMARD (anakinra, infliximab, etanercept, adalimumab, rituximab, abatacept, toc...
243 CitationsSource
#1N. Duru (UU: Utrecht University)H-Index: 2
#2M.C. van der Goes (UU: Utrecht University)H-Index: 5
Last. Johannes W. J. Bijlsma (UU: Utrecht University)H-Index: 88
view all 16 authors...
To develop recommendations for the management of medium to high-dose (ie, >7.5 mg but ≤100 mg prednisone equivalent daily) systemic glucocorticoid (GC) therapy in rheumatic diseases. A multidisciplinary EULAR task force was formed, including rheumatic patients. After discussing the results of a general initial search on risks of GC therapy, each participant contributed 10 propositions on key clinical topics concerning the safe use of medium to high-dose GCs. The final recommendations were select...
120 CitationsSource
18 CitationsSource
Objectives. Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) affect individuals older than 50 years of age and corticosteroids are the mainstay of treatment. The aim of our study was to explore the role of leflunomide as a corticosteroid-sparing agent in GCA and PMR patients. Methods. Patients with difficult-to-treat GCA and PMR were retrospectively identified in the period from 2010 to 2013. The doses of corticosteroids and CRP values were noted before, after three months, and at the...
47 CitationsSource
Abstract Background Glucocorticoids (GC) are the mainstay of treatment of polymyalgia rheumatica (PMR). However GC-related adverse events occur frequently, particularly in patients with relapsing disease. Several studies have demonstrated that IL-6 is a key player in the pathogenesis of PMR. Objectives To report 2 patients with PMR treated with the anti-IL-6 receptor monoclonal antibody tocilizumab (TCZ) and to review the published evidence on the efficacy and safety of TCZ in patients with PMR....
44 CitationsSource
#1Jung Hwa Lee (Konkuk University)H-Index: 2
#2Sang Tae Choi (CAU: Chung-Ang University)H-Index: 8
Last. Hae-Rim Kim (Konkuk University)H-Index: 14
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Polymyalgia rheumatica (PMR) is a common inflammatory disease of the elderly in western countries, but the prevalence is apparently different between races and countries. Until now, an epidemiologic study of PMR is limited in Korea. We retrospectively evaluated the clinical data of 78 patients with PMR who were treated in 5 tertiary hospitals, and analyzed initial laboratory data, symptoms, therapeutic responses, and prognostic factors for relapse 1 year after treatments. Sixty percent of patien...
23 CitationsSource
#1Ali mohammad Nazarinia (Shiraz University of Medical Sciences)H-Index: 1
#2Jamileh Moghimi (Semnan University)H-Index: 4
Last. Jafar Toussi (Semnan University)H-Index: 1
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7 Citations
#1T. AdizieH-Index: 1
#2D. ChristidisH-Index: 1
Last. Bhaskar Dasgupta (University of Essex)H-Index: 35
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Summary Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are related inflammatory rheumatic conditions affecting adults over the age of 50 years. Both conditions respond to initial glucocorticoid (GC) therapy. However, most patients require 12–36 months of a tapering steroid regime. Adverse events at 2 years are seen in up to 65% of patients with PMR and 86% of patients with GCA with over 50% developing serious events. There is also a high incidence of relapse in both diseases −40% wi...
54 CitationsSource
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Zusammenfassung. Die Polymyalgia rheumatica (PMR) ist ein haufiges inflammatorisches Syndrom, welches zusammen mit einer Riesenzellarteriitis (RZA) auftreten kann. Die besondere Schwierigkeit beste...
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BACKGROUND: Only a few population-based studies have examined the association between glucocorticoids and hypertension, with inconsistent results. We aimed to investigate the effect of oral glucocorticoids on incidence of hypertension in adults with chronic inflammatory diseases. METHODS: We analyzed electronic health records from 389 practices in England during 1998–2017 of adults diagnosed with any of 6 chronic inflammatory diseases but with no previous diagnosis of hypertension. We used gluco...
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#1Lena Horvath (University of Tübingen)
#2Bernhard Hellmich (University of Tübingen)H-Index: 35
Patienten mit unbehandelter aktiver Riesenzellarteriitis sind durch das Risiko eines permanenten Visusverlusts akut gefahrdet, sodass umgehend eine Therapie mit Glukokortikoiden in einer Initialdosis von 40–60 mg Prednisolonaquivalent pro Tag begonnen werden sollte. Sobald eine Remission eingetreten ist, sollte die Prednisolon-Dosis innerhalb von 2 bis 3 Monaten auf 15–20 mg und danach innerhalb 1 Jahres auf ≤5 mg pro Tag reduziert werden. Bei Patienten mit erhohtem Risiko fur oder bereits beste...
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#1Sarah L. Mackie (University of Leeds)H-Index: 19
#2Christian Dejaco (University of Graz)H-Index: 27
Last. de, Souza, Aws (UNIFESP: Federal University of São Paulo)
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#1M. FruthH-Index: 1
Last. Jürgen BraunH-Index: 88
view all 6 authors...
OBJECTIVE: There is currently no diagnostic test for PMR. A characteristic pattern of extracapsular inflammation as assessed by contrast-enhanced MRI (ceMRI) has recently been described in the pelvis of patients with PMR. We aimed to evaluate the performance of inflammatory ceMRI signals at predefined pelvic sites as a diagnostic test for PMR. METHODS: Pelvic MRI scans of patients with pelvic girdle pain (n = 120), including 40 patients with an expert diagnosis of PMR and 80 controls with other ...
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After decades of sometimes fierce debate about the advantages and disadvantages of glucocorticoids, an age of convergence has been reached. Current recommendations for the management of diseases such as rheumatoid arthritis (RA), polymyalgia rheumatica and large vessel vasculitis reflect the current consensus that as much glucocorticoid as necessary, but as little as possible, should be used. Over the past few years, a range of glucocorticoid-sparing strategies have been developed, as have tools...
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#1Stina W Borresen (UCPH: University of Copenhagen)
#2Toke Bjørk Thorgrimsen (Copenhagen University Hospital)
Last. Henning Locht (Copenhagen University Hospital)H-Index: 17
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OBJECTIVES: Glucocorticoid treatment is fundamental in polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), but carries a risk of glucocorticoid-induced adrenal insufficiency. Adrenal insufficiency can cause reluctance to stop glucocorticoid treatment after disease remission as symptoms can resemble PMR/GCA flare. We aimed to determine the prevalence of adrenal insufficiency in prednisolone-treated patients with PMR/GCA. METHODS: We included 47 patients with PMR (n = 37), GCA (n = 1) or ...
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#1D. Freier (Charité)H-Index: 1
Last. F. Buttgereit (Charité)H-Index: 1
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Glucocorticoids (GC) have been proven drug substances in rheumatology for more than 70 years. They act very rapidly in high doses through membrane stabilizing effects. Genomic therapeutic effects of GC even in very low doses are mainly due to inhibition of the functions of the transcription factor nuclear factor kappa B (NFkB), which promotes the synthesis of proinflammatory mediators, adhesion molecules and other regulatory proteins. Indications for the use of GC in high doses in rheumatology a...
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#2Kjersti Grønning (NTNU: Norwegian University of Science and Technology)H-Index: 6
Last. Heidi A. Zangi (University of Oslo)H-Index: 10
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BACKGROUND: Patient education (PE) is recommended as an integral part of disease management for people with chronic inflammatory arthritis (IA). There is no consensus on how PE should be evaluated and which outcome measures should be used. OBJECTIVES: This study had three aims: (a) to identify core aspects that PE for patients with IA may impact on; (b) to identify outcome measures to assess changes in these aspects; (c) to test the feasibility and responsiveness of the identified outcome measur...
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#1Sarah L. Mackie (University of Leeds)H-Index: 19
#2Christian Dejaco (University of Graz)H-Index: 27
Last. Alexandre Wagner Silva de Souza (UNIFESP: Federal University of São Paulo)H-Index: 13
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