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Predicting the risk of relapse in polymyalgia rheumatica: novel insights

Diana Prieto-Peña1, Santos Castañeda2, Belén Atienza-Mateo1

  • 1Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués De Valdecilla, IDIVAL, Santander, Spain.

Expert Review of Clinical Immunology
|February 11, 2021
PubMed
Abstract

Insights

Relapses are common in polymyalgia rheumatica (PMR), often occurring with lower prednisone doses. Prednisone tapering speed and genetic factors like HLA-DRB1*0401 influence relapse risk in PMR patients.

Area of Science:

  • Rheumatology
  • Immunology
  • Genetics

Background:

  • Polymyalgia rheumatica (PMR) is a prevalent inflammatory condition affecting individuals over 50, particularly those of Northern European descent.
  • PMR is characterized by pain and stiffness in proximal muscles, with frequent relapses being a significant clinical challenge.
  • Understanding relapse patterns and risk factors is crucial for effective long-term management of PMR.

Purpose of the Study:

  • To review the occurrence, predisposing factors, and management strategies for relapses in polymyalgia rheumatica.
  • To identify clinical, genetic, and serological factors associated with an increased risk of PMR relapse.
  • To discuss therapeutic options for patients experiencing recurrent PMR relapses.

Main Methods:

  • Comprehensive literature search of the PubMed database using keywords 'polymyalgia rheumatica', 'relapses', and 'risk factors'.
  • Review of publications focusing on the timing, frequency, and triggers of PMR relapses.
  • Analysis of studies investigating genetic associations and biomarker data related to PMR disease course.

Main Results:

  • Approximately 50% of PMR patients experience relapses, often when prednisone dosage falls below 5-7.5 mg/day.
  • Rapid glucocorticoid tapering is a primary factor for relapses; genetic factors (HLA-DRB1*0401, IL-6 promoter polymorphism) and elevated angiopoietin-2 levels are associated with increased relapse risk.
  • Treatments like methotrexate and tocilizumab may be necessary for managing patients with frequent PMR relapses.

Conclusions:

  • Relapses are a frequent complication in polymyalgia rheumatica, influenced by medication tapering and genetic predisposition.
  • Identifying patients at high risk for relapse is essential for optimizing treatment strategies.
  • Further research into biomarkers and genetic factors can improve the management of recurrent PMR.
Keywords:
Polymyalgia rheumaticaanti-IL6-receptor tocilizumabgiant cell arteritisglucocorticoidsmethotrexateprednisonerelapses

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