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Published on: May 16, 2025
[Follow-up studies in polymyalgia rheumatica and temporal arteritis]
Jun Li1, Fu-lin Tang, Xiao-dong Wang
1Department of Rheumatology and Immunology, PUMC Hospital, CAMS, PUMC, Beijing 100730, China. linhlicyber@yahoo.com
Objective:
To analyze the clinical course and duration of therapy in 28 patients with polymyalgia rheumatica (PMR) and/or temporal arteritis (TA) for identifying factors that influence prolonged steroid use and relapses.
Methods:
28 cases of PMR and/or TA diagnosed from 1992 to 2001 were retrospectively studied in PUMC hospital. Patients were grouped according to the absence or presence of corticosteroid resistant and relapses.
Results:
Of 28 patients, 22 had pure PMR, 3 had both PMR and TA and 3 had pure TA. 15 patients received corticosteroid therapy and 13 had both corticosteroid and immunosuppressor therapy. The median duration was (25.5 +/- 24.0) months. Increase of white blood cell level and higher baseline erythrocyte sedimentation rate (ESR) were significant risk factors associated with corticosteroid resistant (P < 0.01). Quicker reduction of corticosteroid dose was associated with relapse (P < 0.05).
Conclusions:
Patients with increase of white blood cell level and higher baseline erythrocyte sedimentation rate (ESR) are more likely to be resistant to corticosteroid therapy. Quicker reduction in corticosteroid is more likely to relapse. Immunosuppressor therapy should be added to patients who has corticosteroid resistant, and relapse or PMR associated with TA.
Insights
Patients with polymyalgia rheumatica (PMR) and/or temporal arteritis (TA) experiencing elevated white blood cell counts or high erythrocyte sedimentation rates (ESR) may require prolonged steroid therapy. Rapid steroid dose reduction increases relapse risk.
Area of Science:
- Rheumatology
- Internal Medicine
Context:
- Polymyalgia rheumatica (PMR) and temporal arteritis (TA) are inflammatory conditions often treated with corticosteroids.
- Long-term management of PMR/TA can be complicated by steroid resistance and relapses.
Purpose:
- To identify factors associated with prolonged corticosteroid use and relapses in patients with PMR and/or TA.
- To analyze the clinical course and treatment duration in a cohort of 28 patients.
Summary:
- Higher baseline erythrocyte sedimentation rate (ESR) and elevated white blood cell counts were significant predictors of corticosteroid resistance (P < 0.01).
- A faster reduction in corticosteroid dosage was significantly associated with an increased risk of relapse (P < 0.05).
- Immunosuppressive therapy is recommended for patients with corticosteroid-resistant disease, relapses, or PMR associated with TA.
Impact:
- Findings suggest that specific clinical parameters can predict treatment resistance and relapse in PMR/TA patients.
- Highlights the need for individualized treatment strategies, potentially incorporating immunosuppressants earlier for at-risk patients.
- Informs clinical decision-making regarding corticosteroid tapering and the use of combination therapy in managing PMR and TA.
