Experience of Australian rheumatologists managing polymyalgia rheumatica: results from a national survey

Polymyalgia rheumatica is the commonest inflammatory condition affecting adults over 50 years of age, however it has been under-researched and management varies in everyday clinical practice.

This national survey of rheumatologists and trainees managing polymyalgia rheumatica (PMR) in Australia sought to determine current diagnostic and management approaches and establish a baseline for future development of a disease-specific clinical care standard.

Following ethics approval, an online survey was circulated to the membership of the Australian Rheumatology Association. Relevant demographic information about respondents was collected, along with answers to multiple-choice questions on the clinical presentation, diagnosis, management and prognosis of PMR. Free-text responses were also permitted at the end of each section. The survey remained open between 25 March 2022 and 11 November 2022. Data analysis involved descriptive statistics for multiple-choice questions and thematic analysis for free-text responses.

Seventy-nine clinicians completed the survey, of whom the majority were qualified rheumatologists who regularly managed patients with PMR. Most respondents relied upon clinical diagnosis, but some did not recognise peripheral joint involvement or normal inflammatory markers as possible features of PMR. Access to imaging investigations like ¹⁸F-fluorodeoxyglucose positron emission tomography combined with computed tomography was limited but desirable in circumstances of diagnostic uncertainty. Management predominantly involved glucocorticoid monotherapy; however, long-term outcomes were diverse and almost every clinician had prescribed a conventional synthetic DMARD for steroid-sparing purposes. The use of adjunctive physical therapy was inconsistent.

Variability remains in the diagnosis and management of PMR among Australian clinicians, with gaps in recognition of atypical presentations, imaging access and incorporation of physical therapy, ultimately supporting the need for standardised, evidence-based clinical care guidelines.