Time to remission and steroid doses in older and younger patients with polymyalgia rheumatica

This study aimed to compare time to remission, glucocorticoid doses on the remission achieving regimen, and clinical characteristics between older and younger patients with polymyalgia rheumatica (PMR).

This retrospective cohort study included 157 patients with PMR at a tertiary center. Patients were stratified into older (≥ 65 years, n = 78) and younger (< 65 years, n = 79) groups. Baseline demographics, comorbidities, laboratory findings, and treatment outcomes were compared. The primary outcomes were time to remission and steroid doses at the time of remission.

The mean age was 75.8 ± 8 years in the older group and 60.2 ± 3.3 years in the younger group. The majority of patients were female (82.1% in the older group and 79.7% in the younger group), with no significant difference between groups (P = 0.713). The older group showed a significantly longer time to remission (5.1 ± 1.9 months) compared with the younger group (4.0 ± 1.9 months, P < 0.001). Neutrophil counts were higher in older patients (7.0 ± 2.4 vs. 6.0 ± 2.0 × 10⁹/L, P = 0.004). Hyperlipidemia was more common in the older cohort (P = 0.023). Other comorbidities and inflammatory markers (ESR, CRP) did not differ significantly. Steroid doses required for remission were comparable across groups. Multivariable analysis identified age and neutrophil count as independent predictors of delayed remission.

Older PMR patients experience delayed remission despite similar glucocorticoid regimens. Elevated neutrophil counts may reflect an age-related pro-inflammatory state contributing to persistent disease activity. Tailored, age-adapted therapeutic strategies may improve outcomes in this population.