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Corticosteroids are the standard treatment prescribed in the management of polymyalgia rheumatica (PMR); due to the lack of quality studies, there is, however, a great variability in the initial dose prescribed.1 The European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) recommendations, published in 2015, have proposed starting treatment with an initial dose of between 12.5 and 25 mg prednisone equivalent daily.2 The present study sought to further define the initial dose of corticosteroids prescribed by rheumatologists working in private practices or in university hospital and to compare it to the EULAR/ACR recommendations.
A cross-sectional study was conducted among rheumatologists of the Auvergne region. For each patient with PMR seen at consultation, rheumatologists were invited to collect the following data: length of time since diagnosis of PMR; starting dose of corticosteroid prescribed; weight, age and sex of the patient. Both univariate (correlation coefficient, Student’s t-test, and χ2 test) and multivariate analyses (linear regression) were performed using Stata software (version 13, StataCorp, College Station). For ethics purposes, the study was approved by the CNIL (French Data Protection Authority) (dossier no. 16.292).
Overall, 138 patient records were received, 97 of which from 15 rheumatologists working outside of the rheumatology department and 41 from the rheumatology department. The records concerned 63 men and 75 women, aged 73.4±8.5 years old. The mean length of time since diagnosis of PMR was 2.5±3.1 years; the starting daily dose of corticosteroids prescribed was 19.2±7.7 mg. This dose did not differ for the patients whether they were seen at the rheumatology department (19.9±10.8 mg) or outside of the rheumatology department (18.9±6.1 mg). The dose was revealed inferior to 12.5 mg in three patients (2.2%) and superior to 25 mg in 16 patients (11.9%) (figure 1). In univariate analyses, the dose was not correlated to patient age (r=−0.01; p=0.92), weight (r=0.10; p=0.28), in or outside of the rheumatology department, but was correlated to the length of time since diagnosis (r=0.22; p=0.01). Following multivariate analyses, the correlation to the length of time since diagnosis remained significant (p=0.009). The mean corticosteroid dose was 20.8±9.5 mg before 2016 (prior to the EULAR/ACR recommendations) and 17.5±5.5 mg after 2016 (p=0.02). Following 2016, fewer patients received an initial dose that was inferior or superior to that of the recommendations (6/73 (8%) vs 13/62 (21%); p=0.03)
The corticosteroid dose prescribed is comparable to that of a PMR cohort followed-up in the USA (16±7.1 mg).3 In a population-based study conducted in the UK, 75% of patients received a dose of between 8 and 21 mg.4 These results cannot be unreservedly extrapolated to PMR cases managed by all rheumatologists and above all by family physicians.
The starting dose of corticosteroids prescribed by the rheumatologists of the Auvergne region is perfectly in line with the EULAR/ACR recommendations in 86% of cases and in 92% of cases since the 2015 publication of the recommendations.
Handling editor Josef S Smolen
Contributors Drs Dominique Meyer, Denis Verriere, Sylvie Melac Ducamp, Baptiste Glace, Florence Demarquilly, Milly Gendey, Bernard Maillet, Karim Zbadi, Christine Voquer, Jean Paul Monghal, Abdelkarim Kabchou, Julie Ledoux Eberst, Stella Cecchetti, Jean Meloux, Marielle Vayssade are investigators in the study and are co-authors of this article.
JJD: conception and design of the work, the acquisition and interpretation of data.BP: analysis of the data. AF: acquisition of the data. MS: design of the work and acquisition of the data. All authors: drafting the work or revising it critically for important intellectual content and final approval of the version published. All authors aggree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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