Study on the implementation of the 2015 EULAR/ACR recommendations for polymyalgia rheumatica in clinical practice

To study the implementation of the 2015 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) management recommendations for polymyalgia rheumatica (PMR) among rheumatologists and general practitioners (GPs).

An online survey (Survey Monkey) comprising 28 questions was distributed among members of the EULAR Study Group on PMR and giant cell arteritis (n=375). Each member was asked to invite at least one GP (snowball principle) with experience in PMR to participate. Statistical analysis included descriptive statistics; differences were tested using Fisher's exact test.

There were 308 respondents from 37 countries including data from 211 rheumatologists and 73 GPs. Adherence to the 2015 EULAR/ACR recommendations was higher among rheumatologists (83%) than GPs (35%). Rheumatologists (96%) prescribed glucocorticoids more frequently at dosages within the recommended range than GPs (84%). Concerning tapering, a similar proportion of rheumatologists (83%) and GPs (72%) reached the suggested 10 mg prednisone equivalent after 4-8 weeks. Almost all rheumatologists used methotrexate as a glucocorticoid-sparing agent (95%) as compared with only 26% of GPs. Similarly, 70% of rheumatologists, but only 2% of GPs, had experience with interleukin-6 receptor inhibitors for PMR. For follow-up, more rheumatologists preferred scheduled (as opposed to on demand) visits than GPs (99% vs 82%), while more GPs than rheumatologists (47% vs 31%) planned a short follow-up interval (4-8 weeks) in the first year of disease.

Implementation of the EULAR/ACR recommendation for the management of PMR remains incomplete, particularly among GPs. Future updates should incorporate projects to foster diffusion and implementation of the recommendations among all professionals managing this disease.