Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease of the elderly conventionally treated with long-term oral corticosteroids. Initial glucocorticoid (GC) dose, GC tapering regimen and the use of GC sparing agents, however, are subject to wide variation in clinical practice. New ACR/EULAR guidelines for treatment of PMR are being developed to support the management of the disease by primary care physicians and specialists.MEDLINE, Embase, PubMed, CINAHL, Web of Science and the Cochrane Library using pre-specified questions in the “PICO” formant regarding initial GC doses, length, tapering and administration of GC treatment as well as the use of NSAIDs, intramuscular methylprednisolone (i.m. MP), synthetic and biologic disease modifying anti-rheumatic drugs and non-pharmacological interventions. In addition, we searched articles on the prognostic value of age, sex, baseline inflammatory markers, disease activity/severity, presence of peripheral arthritis, symptom duration, concomitant conditions relevant to PMR and/or disease management with GC therapy, response to GC, shared patients' management by primary and secondary care providers and optimal control management on patients' outcomes. Out of 10078 records, we identified 25 articles on interventions and 37 papers on prognostic factors meeting our inclusion and exclusion criteria. Overall, there was low quality of evidence (QoE) on the use of NSAIDs, initial GC doses and tapering regimens as well as non-pharmacological interventions. Moderate QoE was available for intramuscular GCs and low to high QoE was found on the use of methotrexate in PMR. Studies on biological agents were of low to moderate quality. The quality of studies on prognostic factors was variable as determined by the Quality In Prognosis Studies (QUIPS) tool. Most papers were retrieved on the relevance of female sex, high erythrocyte sedimentation rate (ESR) and peripheral arthritis with divergent conclusions. Fewer or even no studies were found on the prognostic value of the other factors mentioned above.
We used GRADE methodology as a framework for the guidelines development process. A systematic literature review was conducted corroborating current evidence on therapeutic interventions as well as baseline prognostic factors. We searched several medical databases including
In summary, there are only few high quality studies on interventions and prognostic factors in PMR. Most data are available on the use of methotrexate whereas initial GC doses, tapering regimens and other interventions were less frequently studied. Concerning prognostic factors, most reports focused the value of female sex, high erythrocyte sedimentation rate and the presence of peripheral arthritis.
Disclosure of Interest None declared