AB1224 Clinical characteristics and prognostic factors for relapse in korean patients with polymyalgia rheumatica
Authors: J. Lee, S.-H. Lee, H.-R. Kim, J.-H. Woo
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Polymylgia rheumatic (PMR) is an inflammatory rheumatic disease characterized by pain and stiffness in the shoulders, pelvic girdles and neck. PMR is generally associated with elevation of acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Although PMR is often underestimated, it is common in the elderly from Western countries, and the prevalence was apparently different according to race until now. Standard therapy is oral steroids, but there is considerable heterogeneity in pateints' clinical courses, steroid requirements for suppression of symptoms and the likelihood of relapses. An epidemiologic study of PMR in Korea is limited. <h3>Objectives</h3> This study aims to find the clinical characteristics and prognostics factors of Korean patients with PMR. <h3>Methods</h3> We retrospectively evaluated the clinical data of 78 Korean patients with PMR who were treated in 5 tertiary hospitals, and analyzed the therapeutic response and prognostic factors of 39 patients who were followed up at least 1 year. <h3>Results</h3> Of 78 patients, 51 (65.4%) were women, with a mean age of 68.3±9.2 years. There was no giant cell arteritis in our case series. After 4 weeks of steroid therapy, patient-reported global improvement and ESR response was poor compared to a previous study. Only 57.6% of the patients achieved ≥50% improvement of symptoms and ESR was elevated in 60% of the patients. The rate of relapse (46.1%) was similar to that of previous reports, but only 20.5% of patients reached remission. Relapse occurred mostly in a year, especially between 6-12 months after diagnosis. The rate of relapse and remission at one year of follow-up was 38.4% and 2.5%, respectively. The percentage of females was higher in relapse group (88.9%, p=0.037). Cumulative steroid dose was significantly higher in the relapse group. Independent risk factors for relapse were initial CRP ≥2.5 mg/dl (OR 6.296, p=0.047) and the use of hydroxychloroquine (OR 6.798, p=0.035). Initial steroid dose and tapering speed did not influence prognosis. <h3>Conclusions</h3> In Korean patients with PMR, baseline clinical characteristics including relapse rate was similar to previous reports, but of special interest, our patients rarely accompanied giant cell arteritis and showed lower remission rate as well as delayed therapeutic response and later occurrence of relapse. More aggressive management will be needed according to the clinical status of patients. <h3>References</h3> Salvarani C, Cantini F, Boiardi L, Hunder GG (2002) Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 347:261-271. Lawrence RC, Felson DT, Helmick CG et al (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 58:26-35. Gonzalez-Gay MA, Agudo M, Martinez-Dubois C, Pompei O, Blanco R (2010) Medical management of polymyalgia rheumatica. Expert Opin Pharmacother 11:1077-1087 Dasgupta B, Borg FA, Hassan N et al (2010) BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford) 49:186-190 Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE (2005) Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol 32:65-73. <h3>Disclosure of Interest</h3> None Declared