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Predictors of complete 24-month remission and flare in patients with polymyalgia rheumatica

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Abstract

To date, few papers investigated the predictive factors of sustained 24-month remission and of flare in patients with polymyalgia rheumatica (PMR). We retrospectively evaluated clinical charts from PMR patients. Patients were evaluated at baseline, at 1 month, 3 months and subsequently at 6, 12 and 24 months. We analyzed the differences between patients who achieved remission within 6 months of diagnosis, those who achieved remission at 24 months, and patients who did not. Among 137 patients, 57 (41.6%) achieved remission at 6 months and complete remission at 24 months was achieved by 104 patients (75.9%). The erythrocyte sedimentation rate at baseline was higher in patients who did not achieve remission than in patients who achieved it (p = 0.012). Female patients were less likely to achieve complete remission (45/68, 66.2% vs. 59/69, 85.5%, p = 0.01) compared to males. Fifty-four patients (39.4%) experienced at least one flare. Patients who did not achieve sustained complete remission suffered a flare more often (22/39 vs. 32/98, p = 0.01) and earlier than patients who did (10.33 ± 7.89 months vs. 13.64 ± 6.97 months, p = 0.011). Multivariate analysis confirmed that female sex (RR = 3.2, 95% CI 1.3–7.9) and higher baseline prednisone dosage (RR = 1.1, 95% CI 1.007–1.109) were negative independent predictors of complete remission at 24 months. A significant percentage of patients with PMR requires prolonged steroid treatment and may experience flares at 24 months of follow-up. Female sex and higher baseline prednisone dosage are negative independent predictors of complete remission at 24 months.

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Authors and Affiliations

  1. Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy

    Carlo Perricone, Giacomo Cafaro, Elena Fiumicelli, Roberto Bursi, Ilenia Riccucci, Roberto Gerli & Elena Bartoloni

  2. Internal Medicine and Autoimmune Diseases, Department Internal Medicine, University of Thessaly, Larissa, Greece

    Dimitrios Bogdanos

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  1. Carlo Perricone
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Contributions

CP conceptualized the study and wrote the original draft; EF acquired the data; GC, RB, IR, RG, EB helped in investigation and resources; CP and EF curated the data; CP, GC, DB, EB contributed to writing—review and editing; RG supervised the study. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Carlo Perricone.

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Perricone, C., Cafaro, G., Fiumicelli, E. et al. Predictors of complete 24-month remission and flare in patients with polymyalgia rheumatica. Clin Exp Med 23, 3391–3397 (2023). https://doi.org/10.1007/s10238-022-00976-0

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