Abstract
The objective of this study was to evaluate glucocorticoid (GC) use in patients with polymyalgia rheumatica (PMR), giant cell arteritis (GCA) or both diseases (PMR + GCA) under rheumatological care. Data from patients with PMR (n = 1420), GCA (n = 177) or PMR + GCA (n = 261) from the National Database of the German Collaborative Arthritis Centers were analyzed regarding GCs and related comorbidities (osteoporosis, diabetes and cardiovascular disease), stratified by disease duration (DD). Longitudinal data were analyzed for all patients with a DD ≤ 2 years at database entry (n = 1397). Three-year data were available for 256 patients. Predictors of GC use ≥ 3 years were examined by logistic regression analyses. A total of 76% received GCs, and 19% (PMR) to 40% (GCA) received methotrexate. Median GC doses were 12.5 mg (PMR), 11.3 mg (GCA), and 20.0 mg/day (PMR + GCA) in a 0–6-month DD. Median GC doses ≤ 5 mg/day were reached at a 13–18-month DD in PMR patients and at a 19–24-month DD in GCA or PMR + GCA patients. In the multivariate analysis, baseline methotrexate (OR 2.03, [95% CI 1.27–3.24]), GCs > 10 mg/day (OR 1.65, [1.07–2.55]), higher disease activity (OR 1.12, [1.02–1.23]) (median 0.6 years DD), and female sex (OR 1.63 [1.09–2.43]) were predictive for GC therapy at ≥ 3 years. Of the examined comorbidities, only osteoporosis prevalence increased within 3 years. GC use for ≥ 3 years was reported in one-fourth of all the patients. A difficult-to-control disease activity within the first year was a good predictor of long-term GC need.
Similar content being viewed by others
References
Buttgereit F, Dejaco C, Matteson EL, Dasgupta B (2016) Polymyalgia rheumatica and giant cell arteritis: a systematic review. JAMA 315:2442–2458
Matteson EL, Buttgereit F, Dejaco C, Dasgupta B (2016) Glucocorticoids for management of polymyalgia rheumatica and giant cell arteritis. Rheum Dis Clin North Am 42:75–90
Dejaco C, Singh YP, Perel P et al (2015) 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 74:1799–1807
Dasgupta B, Borg FA, Hassan N et al (2010) BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford) 49:1594–1597
Gabriel SE, Sunku J, Salvarani C, O’Fallon WM, Hunder GG (1997) Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum 40:1873–1878
Narvaez J, Nolla-Sole JM, Clavaguera MT, Valverde-Garcia J, Roig-Escofet D (1999) Longterm therapy in polymyalgia rheumatica: effect of coexistent temporal arteritis. J Rheumatol 26:1945–1952
Cimmino MA, Salvarani C, Macchioni P et al (2008) Long-term follow-up of polymyalgia rheumatica patients treated with methotrexate and steroids. Clin Exp Rheumatol 26:395–400
Chandran A, Udayakumar PD, Kermani TA, Warrington KJ, Crowson CS, Matteson EL (2015) Glucocorticoid usage in giant cell arteritis over six decades (1950 to 2009). Clin Exp Rheumatol 33(2 Suppl 89):S-102
Proven A, Gabriel SE, Orces C, O’Fallon WM, Hunder GG (2003) Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum 49:703–708
Van der Goes MC, Jacobs JW, Boers M et al (2010) Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 69:1015–1021
Mazzantini M, Di Munno O (2014) Glucocorticoid-induced osteoporosis: 2013 update. Reumatismo 66:144–152
Katsuyama T, Sada KE, Namba S et al (2015) Risk factors for the development of glucocorticoid-induced diabetes mellitus. Diabetes Res Clin Pract 108:273–279
Albrecht K, Huscher D, Richter J, Backhaus M, Bischoff S, Kotter I et al (2014) Change in referral, treatment and outcomes in patients with systemic lupus erythematosus in Germany in the 1990s and the 2000s. Lupus Sci Med 1:e000059
Huscher D, Thiele K, Rudwaleit M, Albrecht KC, Bischoff S, Krause A et al (2015) Trends in treatment and outcomes of ankylosing spondylitis in outpatient rheumatological care in Germany between 2000 and 2012. RMD Open 1:e000033
Restuccia G, Boiardi L, Cavazza A et al (2017) Long-term remission in biopsy proven giant cell arteritis: a retrospective cohort study. J Autoimmun 77:39–44
Restuccia G, Boiardi L, Cavazza A et al (2016) Flares in biopsy-proven giant cell arteritis in Northern Italy: characteristics and predictors in a long-term follow-up study. Medicine (Baltimore) 95:e3524
Lally L, Forbess L, Hatzis C, Spiera R (2016) Brief report: a prospective open-label phase IIa trial of tocilizumab in the treatment of polymyalgia rheumatica. Arthritis Rheumatol 68:2550–2554
Devauchelle-Pensec V, Berthelot JM, Cornec D et al (2016) Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatica: a prospective longitudinal study. Ann Rheum Dis 75:1506–1510
Langford CA, Cuthbertson D, Ytterberg SR et al (2017) A randomized, double-blind trial of abatacept (CTLA-4Ig) for the treatment of giant cell arteritis. Arthritis Rheumatol 69:837–845
Pujades-Rodriguez M, Duyx B, Thomas SL, Stogiannis D, Smeeth L, Hemingway H (2016) Associations between polymyalgia rheumatica and giant cell arteritis and 12 cardiovascular diseases. Heart 102:83–89
Petri H, Nevitt A, Sarsour K, Napalkov P, Collinson N (2015) Incidence of giant cell arteritis and characteristics of patients: data-driven analysis of comorbidities. Arthritis Care Res (Hoboken) 67:390–395
Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE (2005) Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol 32:65–73
Hernandez-Rodriguez J, Cid MC, Lopez-Soto A, Espigol-Frigole G, Bosch X (2009) Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med 169:1839–1850
Acknowledgements
The authors gratefully acknowledge the contributions and the enthusiasm of all the participating patients and consultant rheumatologists who contributed data to the National Database. The authors would like to acknowledge the significant contributions of R. Alten (Berlin), M. Backhaus (Berlin), H. Burkhardt (Frankfurt/Main), S. Kleinert and J. Wendler (Erlangen), T. Eidner (Jena), K. Fischer (Greifswald), J. Henes (Tübingen), U. von Hinüber (Hildesheim), K. Karberg (Berlin), I. Kötter (Hamburg), A. Krause (Berlin), S. Späthling-Mestekemper (München), J. Richter (Düsseldorf), S. Wassenberg and R. Weier (Ratingen).
Author information
Authors and Affiliations
Contributions
DH had full access to all data of this study and take responsibility for data integrity and accuracy of the analysis. KA, DH, FB and AZ: study concept and design. MA, GH, WO and KT: acquisition of the data. KA, DH, FB, MA and AZ: analysis and interpretation of the data. KA and DH: drafting the manuscript. All authors critically revised the manuscript for important intellectual content.
Corresponding author
Ethics declarations
Funding
The database is funded by unconditional grants from the German Collaborative Arthritis Centers and from a consortium of 11 pharmaceutical companies to the German Academy for Continuing Medical Education in Rheumatology. The principal investigators and their team had full academic freedom in the study design and conduct, data analysis and publication of the results.
Conflict of interest
M.A. is an investigator in a tocilizumab trial of GCA. F.B. reported receiving consultancy fees, honoraria and travel expenses from Horizon Pharma (formerly Nitec Pharma) and Mundipharma Int Ltd and grant support from Horizon Pharma. In addition, he serves as co-principal investigator and site investigator in a Mundipharma sponsored trial in PMR investigating the effects of MR prednisone. None of the other authors have conflicts of interest to declare.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Katinka Albrecht and Dörte Huscher contributed equally to this work.
Rights and permissions
About this article
Cite this article
Albrecht, K., Huscher, D., Buttgereit, F. et al. Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database. Rheumatol Int 38, 569–577 (2018). https://doi.org/10.1007/s00296-017-3874-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-017-3874-3