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Rheumatology International

, Volume 38, Issue 4, pp 569–577 | Cite as

Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database

  • Katinka Albrecht
  • Dörte Huscher
  • Frank Buttgereit
  • Martin Aringer
  • Guido Hoese
  • Wolfgang Ochs
  • Katja Thiele
  • Angela Zink
Cohort Studies on Comorbidities

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.

Keywords

Polymyalgia rheumatica Giant cell arteritis Glucocorticoids Immunosuppressive agents Comorbidities 

Notes

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 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.

Compliance with ethical standards

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.

References

  1. 1.
    Buttgereit F, Dejaco C, Matteson EL, Dasgupta B (2016) Polymyalgia rheumatica and giant cell arteritis: a systematic review. JAMA 315:2442–2458CrossRefPubMedGoogle Scholar
  2. 2.
    Matteson EL, Buttgereit F, Dejaco C, Dasgupta B (2016) Glucocorticoids for management of polymyalgia rheumatica and giant cell arteritis. Rheum Dis Clin North Am 42:75–90CrossRefPubMedGoogle Scholar
  3. 3.
    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 74:1799–1807CrossRefPubMedGoogle Scholar
  4. 4.
    Dasgupta B, Borg FA, Hassan N et al (2010) BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford) 49:1594–1597CrossRefGoogle Scholar
  5. 5.
    Gabriel SE, Sunku J, Salvarani C, O’Fallon WM, Hunder GG (1997) Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum 40:1873–1878CrossRefPubMedGoogle Scholar
  6. 6.
    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 26:1945–1952PubMedGoogle Scholar
  7. 7.
    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 26:395–400PubMedGoogle Scholar
  8. 8.
    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-102Google Scholar
  9. 9.
    Proven A, Gabriel SE, Orces C, O’Fallon WM, Hunder GG (2003) Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum 49:703–708CrossRefPubMedGoogle Scholar
  10. 10.
    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 69:1015–1021CrossRefPubMedGoogle Scholar
  11. 11.
    Mazzantini M, Di Munno O (2014) Glucocorticoid-induced osteoporosis: 2013 update. Reumatismo 66:144–152CrossRefPubMedGoogle Scholar
  12. 12.
    Katsuyama T, Sada KE, Namba S et al (2015) Risk factors for the development of glucocorticoid-induced diabetes mellitus. Diabetes Res Clin Pract 108:273–279CrossRefPubMedGoogle Scholar
  13. 13.
    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:e000059CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    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:e000033CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Restuccia G, Boiardi L, Cavazza A et al (2017) Long-term remission in biopsy proven giant cell arteritis: a retrospective cohort study. J Autoimmun 77:39–44CrossRefPubMedGoogle Scholar
  16. 16.
    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:e3524CrossRefGoogle Scholar
  17. 17.
    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 68:2550–2554CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    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 75:1506–1510CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    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 69:837–845CrossRefPubMedGoogle Scholar
  20. 20.
    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 102:83–89Google Scholar
  21. 21.
    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) 67:390–395CrossRefGoogle Scholar
  22. 22.
    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 32:65–73PubMedGoogle Scholar
  23. 23.
    Hernandez-Rodriguez J, Cid MC, Lopez-Soto A, Espigol-Frigole G, Bosch X (2009) Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med 169:1839–1850CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Epidemiology UnitGerman Rheumatism Research Center, A Leibniz InstituteBerlinGermany
  2. 2.Department of Rheumatology and Clinical ImmunologyCharité University HospitalBerlinGermany
  3. 3.Department of Rheumatology and Clinical ImmunologyTU DresdenDresdenGermany
  4. 4.Private Specialty Practice for RheumatologyStadthagenGermany
  5. 5.Private Specialty Practice for RheumatologyBayreuthGermany

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