AB0516 INITIAL TREATMENT OF POLYMYALGIA RHEUMATICA PATIENTS: COMPARISONS BETWEEN GENERAL PRACTITIONERS AND THE RHEUMATOLOGIST.
Authors: A. Orya, N. Svendsen, P. Lage-Hansen, N. J. Kock, A. Diamandopoulos, S. Chrysidis
Journal: Annals of the Rheumatic Diseases (2020)

Background: Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease at persons &gt; 50 years of age. It is clinically characterized by pain and stiffness in the neck, proximal shoulder, and hip girdle. (1)Glucocorticoid (GC) is the cornerstone of PMR treatment; the use is associated with potentially severe side effects (3).According to EULAR-ACR recommendations for the management of PMR, treatment should be individualized using the minimum effective GC dose. (2) An initial prednisolone dose of &gt; 15mg is associated with significantly higher risk for GCs related side effects (1) and GC doses higher than 25 mg/day are discouraged because of the high risk of adverse events; furthermore, there is no evidence that such doses are more effective than lower doses (2,3). In most countries, the vast majority of PMR patients are diagnosed and managed primarily by their General Practitioner (GP) (4) Objectives: To compare the initial GC dose for PMR patients diagnosed by their GP versus an outpatient rheumatological clinic in Denmark. Methods: All patients with the diagnosis of PMR in South-West Jutland Hospital, Denmark at the period of 2013 to 2018 were identified from an electronic register. Patients with an already known rheumatic disease before the diagnosis of PMR, GCA symptoms at the diagnosis time or hospitalized at the diagnostic time were excluded. Clinical and paraclinical data were collected from the patient’s electronic journal. Results: In a period of 6 years, 342 patients with PMR were identified. Of 342 patients 83 were diagnosed by their GP. No significant differences were found regarding demographical, clinical and paraclinical baseline characteristics between the two groups. No differences were identified regarding the treatment response. However the initial prednisone dose in patients diagnosed by the GP’s was significantly higher (p&lt;0, 00001) compared to the rheumatological outpatient clinic (Table 1) with an initial dose of ≥25mg at over 50% of newly diagnosed cases (45 patients). Table 1. Diagnosed by GPs N 83 Diagnosed by the rheumatological outpatient clinic N 259 P values Age (years) ± SD 70,2 ± 8,2 70,58± 7,5 n.s* Gender-female(% ) 62,6% 56,7% n.s* Duration of symptoms (weeks ) ± SD 12,34 ± 10 12,9 ± 13,4 n.s* Age over 50 % 98,8% 99,6% n.s Bilateral shoulder pain (% ) 95,1% 96,5% n.s Abnormal CP and/or SR (% ) 87,8% 94,2% n.s* CRP (mg/lt) ± SD 36,8 ± 32,2 45,8± 36,8 n.s* SR(mm/hour) ± SD 50,1±26,5 55,1±23,7 n.s* Morning stiffness 87,9% 91% n.s* Hip pain or limited range of motion 66,2% 70,4% n.s* RF and aCCP negative % 87,9% 90,2% n.s* Absence of other joint involvement 79,5% 71% n.s* Initial prednisolone dose(mg) ± SD 25,65 ± 12,1 16,4±4,5 &lt;0,0001 Response to treatment 93,9% 94,1% n.s *non-significant Conclusion: Our study shows that the initial GC dose is significantly higher for PMR patients diagnosed by GPs which may lead to a higher risk of GC related side effects. References: [1]Camellino D, Dejaco C. Update on treatment of polymyalgia rheumatica Reumatismo. 2018 Mar 27;70(1):59-66. doi: 10.4081/reumatismo.2018.1062. [2]Dejaco C, Singh YP, Perel P, et al. 2015 recommendations for the management of polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2015; 74: 1799-807 [3]Dejaco C, Singh YP, Perel P, et al. Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica: a systematic literature review informing the 2015 European League Against Rheumatism/ American College of Rheumatology recommendations for the management of po. Ann Rheum Dis. 2015; 74: 1808-17. [4]Helliwell T, Muller S, Hider SL, Zwierska I, Lawton S, Richardson J, Mallen C. Challenges of diagnosing and managing polymyalgia rheumatica: a multi methods study in UK general practice. Br J Gen Pract. 2018 Nov;68(676):e783-e793. doi: 10.3399/bjgp18X699557. Disclosure of Interests: None declared