Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database
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.
KeywordsPolymyalgia rheumatica Giant cell arteritis Glucocorticoids Immunosuppressive agents Comorbidities
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).
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
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.
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 was obtained from all individual participants included in the study.
- 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
- 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
- 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