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Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls
J T Gran1, G Myklebust, T Wilsgaard
1Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway.
Objective:
To estimate survival in polymyalgia rheumatica (PMR) and temporal arteritis (TA).
Methods:
The present study encompassed 338 incident cases who were diagnosed at the Department of Rheumatology during the period 1987-1997 and 60 cases diagnosed in the same period but admitted to hospital for reasons other than PMR or TA. The 398 patients were each assigned four age- and sex-matched controls from the same population and mortality ascertained.
Results:
Among the 338 incident cases, there were 69 deaths compared with 360 deaths among their 1352 controls. The mortality was thus 28% lower in cases than in controls [relative risk (RR)=0.72, 95% confidence interval (CI) 0.55-0.95]. The 274 incident cases with pure PMR had increased survival compared with controls (RR=0.70, 95% CI 0.52-0.95), whilst among the 64 incident TA patients and their controls, no difference in mortality was found (RR=1.2, 95% CI 0.55-2.74). Patients diagnosed at other departments and their controls had the same mortality. In the incident cases, the mean initial dose of prednisolone, the mean maintenance dose of prednisolone, the mean initial erythrocyte sedimentation rate and C-reactive protein and frequency of peripheral arthritis did not differ between survivors and those dying during the observation period.
Conclusion:
The study showed increased survival in patients with PMR compared with controls, whilst mortality in TA equalled that of controls. There was no association between use of corticosteroids and level of disease activity and death. The increased survival in PMR might be explained by improved medical surveillance.
Insights
Patients with polymyalgia rheumatica (PMR) show increased survival, while those with temporal arteritis (TA) have similar mortality rates to controls. Improved medical surveillance may explain the better outcomes in PMR patients.
Area of Science:
- Rheumatology
- Epidemiology
- Clinical Medicine
Background:
- Polymyalgia rheumatica (PMR) and temporal arteritis (TA) are common inflammatory conditions in older adults.
- Understanding the long-term survival of patients diagnosed with PMR and TA is crucial for patient management and public health.
- Previous studies on PMR and TA survival have yielded varied results, necessitating further investigation.
Purpose of the Study:
- To estimate and compare the survival rates of patients diagnosed with polymyalgia rheumatica (PMR) and temporal arteritis (TA) against matched controls.
- To investigate potential factors influencing survival, including disease activity and corticosteroid use.
Main Methods:
- A cohort study design involving 338 incident cases of PMR/TA diagnosed between 1987-1997.
- Each case was matched with four age- and sex-matched controls from the general population.
- Mortality data for cases and controls were ascertained and analyzed using relative risk (RR) and confidence intervals (CI).
Main Results:
- Overall, PMR/TA cases exhibited a 28% lower mortality rate compared to controls (RR=0.72, 95% CI 0.55-0.95).
- Patients with pure PMR showed significantly increased survival (RR=0.70, 95% CI 0.52-0.95), whereas TA patients had mortality similar to controls (RR=1.2, 95% CI 0.55-2.74).
- No significant differences in mortality were observed between survivors and non-survivors regarding initial prednisolone dose, maintenance dose, inflammatory markers (ESR, CRP), or peripheral arthritis frequency.
Conclusions:
- Polymyalgia rheumatica (PMR) is associated with increased survival, while temporal arteritis (TA) shows mortality comparable to the general population.
- Corticosteroid use and disease activity levels were not found to be associated with death in this cohort.
- Enhanced medical surveillance is a potential factor contributing to the improved survival observed in PMR patients.