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Incidence of inflammatory polyarthritis in polymyalgia rheumatica: a population-based cohort study
  1. Max Yates1,2,
  2. Jalpa Kotecha1,
  3. Richard A Watts1,3,
  4. Robert Luben4,
  5. Kay-Tee Khaw5,
  6. Alexander J MacGregor1,2
  1. 1 Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, UK
  2. 2 Department of Rheumatology, Norfolk and Norwich University Hospital, London, UK
  3. 3 Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, UK
  4. 4 EPIC University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
  5. 5 Clinical Gerontology Unit, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to Dr Max Yates, Norwich Medical School, University of East Anglia, Norwich NR4 7UQ, UK; maxyates{at}doctors.org.uk

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The relationship between polymyalgia rheumatica (PMR) and inflammatory polyarthritis (IP) remains a source of debate in rheumatology: although both conditions have been classified separately as distinct entities, they share many clinical features.1–4 It remains unclear whether synovitis in IP is part of a spectrum of PMR, or if the symptoms of PMR are early manifestations of a distinct diagnosis of IP. Alternatively, the arthritis that develops in PMR might represent a phenotypic transformation in susceptible individuals.

We examined the risk of IP following the diagnosis of PMR in the data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study, a prospective population-based cohort.5 Incident cases of PMR were identified retrospectively among 24 068 volunteers enrolled after 2002 by (1) free-text questionnaire responses at baseline, 18 months, and at 3, 10 and 13 years; (2) linkage to hospital electronic discharge summaries containing International Classification of Diseases codes; and (3) linkage to keyword searches (polymyalgia or rheumatica) of outpatient clinic letters. To be identified as PMR, participants were required to …

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