Background The limited evidence on gender differences in outcomes in PMR suggests females experience a more severe and protracted course of disease. Females have longer duration of symptoms, higher relapse rate, higher cumulative steroid dose, and more steroid complications.
Objectives To determine gender outcome differences in the first two years of PMR by analysing an existing database.
Methods The analyses use data from a UK multi-centre prospective cohort study (2000-2005) of 129 patients (77 females, 52 males). Patients received standard care of, tapering oral prednisolone treatment in-line with current BSR guidelines. Clinical and patient-reported outcomes were assessed prior to starting treatment and at five assessments during two year follow-up. Health-related quality of life was measured using mental and physical component scores of the SF-36. Statistical analysis was done using multivariable linear and logistic regression to examine differences in outcomes by gender. Analyses were adjusted for socio-economic status, age, co-morbidities, and pre-treatment differences in the relevant outcome measure.
Results At presentation females had worse mental quality of life (p=0.01.) There was no evidence of a difference in physical quality of life (p=0.54.) During follow-up females had significantly less improvement in physical quality of life (p=0.04 at 12 months, p=0.01 at 24 months). There were no statistically significant differences between females and males in improvement in mental quality of life (p=0.38 at 12 months, p=0.65 at 24 months.) The percentage of females who relapsed in the first two years was higher but non-significant (57% versus 44%). The cumulative steroid dose was higher in females despite their mean 13% lower body weight (3930mg versus 3548mg). Females had twice as many steroid related adverse events as males.
Conclusions Females with PMR have worse mental quality of life at initial presentation, a difference that remains during follow-up. Although relapse rates were not significantly different in females and males, there were significant differences in outcome in terms of physical quality of life. Cumulative steroid dose was higher in females despite lower body weight and steroid related adverse events were double those of males. Our findings add to existing evidence of worse outcomes in females and suggest the need to consider alternative approaches to treatment.
Disclosure of Interest: None Declared