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Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice

Toby Helliwell1, Samantha Lara Hider, Christian David Mallen

  • 1Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire. t.helliwell@keele.ac.uk

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|May 7, 2013
PubMed
Abstract

Insights

Management of polymyalgia rheumatica (PMR) in UK primary care shows variation. Improved diagnostic exclusion and prophylaxis for treatment complications are recommended for better patient outcomes in polymyalgia rheumatica (PMR) care.

Area of Science:

  • Rheumatology
  • Primary Care Medicine
  • Clinical Practice Research

Background:

  • Polymyalgia rheumatica (PMR) is a prevalent rheumatological condition in older adults.
  • Diagnosis and management of PMR predominantly occur in UK general practice.
  • Current primary care practices exhibit significant variability and underutilization of diagnostic criteria.

Purpose of the Study:

  • To investigate the diagnostic procedures, treatment strategies, and monitoring practices for PMR patients within UK primary care settings.
  • To identify areas for potential optimization in the primary care management of polymyalgia rheumatica.

Main Methods:

  • A retrospective cohort study design was employed.
  • Data were extracted from linked primary care databases in North Staffordshire.
  • Patient records were identified using Read Codes, with subsequent review of investigations, prescriptions, and consultations.

Main Results:

  • Analysis of 304 patient records revealed documented PMR symptoms in 81.6%.
  • Exclusion of differential diagnoses was documented in only 22.4% of patients.
  • Referral to specialist care occurred in 44.4%, with gastric and osteoporosis prophylaxis rates at 28.0% and 60.2% respectively. Complications included osteoporosis (3.9%) and gastric symptoms (18.4%).

Conclusions:

  • The current management of polymyalgia rheumatica in general practice warrants optimization.
  • Key areas for improvement include rigorous documentation of differential diagnosis exclusion and proactive prophylaxis for treatment-related complications such as osteoporosis and gastric issues.

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