Background Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder which usually affect patients over 65 years old. Different poor prognostic factors are involved in prednisone response including rapid decrease of prednisone dose or female sex. To date, there is no data relating the impact of the age on therapeutic response in PMR.
Objectives The aim of this study was to compare, in case of PMR, the response to prednisone in patients younger than 60 to patients over 65 years old.
Methods This was a retrospective, monocentric study. We included patients suffering from PMR, meeting ACR 2012 criteria. Patients were classified into two groups, one group with patients less than 60 years, and one group with patients over 65 years. We registered demographic, clinical, biological, and imaging data as well as therapeutic response profile. The local inflammation was evaluated with PET scan, by studying each anatomical site usually affected by PMR. Then, the rate of inflammation was scored from 0 to 3, according to the intensity of uptake compared to liver. The treatment was standardized. The initial dose of prednisone was of 0.3mg/kg/j during the two first weeks, then, the dose was slowly decreased by 10% each month. The main endpoint was a steroid dependence defined by the recurrence of PMR symptoms and/or the increase of CRP at two times during the decrease of prednisone.
Results We included 14 patients younger than 60 years old (average age 54+/- 0.8 years) and 28 patients older than 65 years old (average age 75.8 +/- 1.5 years). The population younger than 60 years was mainly male (60% VS 27%, p<0.05). Both groups were similar in terms of morning stiffness (2,1±0,4 VS 1,9±0,3 hours; p>0.05), disease duration (4,2±0,8 VS 4,1±0,6 months; p>0.05), leukocytes rate (8,3±1,37 VS 8±0,7 G/L; p>0.05) and percentage of antinuclear antibodies rate over 1/320 (20% VS 10%; p>0.05). However, regarding to local inflammation, the intensity of FDG uptake highlighted by the Pet scan was lower among young patients (score of 16,9±1,7 VS 26,5±3,0; p<0.05). Furthermore, we observed a significant difference concerning therapeutic response according to the age: 60% of the young patients developed a steroid dependence compared to20% in group of old patients (p<0.05). Moreover, the introduction of methotrexate was necessary for 35% of the young patients against 6.5% (p<0.05).
Conclusions Our study is the first to highlight the age as a bad prognosis factor in case of PMR. This difference is independent to the systemic inflammation and surprisingly, local inflammation (assessed by the TEP score) is more important in elderly people. Young patients suffering from PMR are mostly men and are more dependent on steroids. Thus, methotrexate could be straightaway proposed, particularly in patient younger than 60 years old.
Disclosure of Interest None declared