FRI0527 THE EFFECT OF A NURSE-LED PREDNISOLONE TAPERING REGIME IN POLYMYALGIA RHEUMATICA: A RETROSPECTIVE COHORT STUDY
Authors: C. Mork, M. Yde Matthiesen, M. Callsen, K. Keller
Journal: Annals of the Rheumatic Diseases (2020)

Background: The cornerstone treatment of polymyalgia rheumatic (PMR) is prednisolone, which has several side effects such as osteoporosis and type 2 diabetes [1]. Therefore, the duration of prednisolone treatment should be as short as possible. Previous studies indicate that only 10-30% has discontinued prednisolone after 1 year and approximately 50% after 2 years [2]. Objectives: To investigate the efficacy of a nurse-led prednisolone tapering regime in patients with PMR compared to usual care. Methods: The study is a single center retrospective cohort study with a 2-year follow-up. Prednisolone dose was evaluated after 1 and 2 years. A nurse-led PMR clinic was introduced June 1st, 2015 and patients diagnosed until June 7th, 2017 were included. Patients were diagnosed by a physician, and subsequently managed by nurses according to a specific protocol, with prednisolone tapering from 15 mg to discontinuation after 52 weeks. Regularly blood tests and telephone interviews were performed and a rheumatologist was involved if deemed necessary. Patients diagnosed with PMR between June 1st, 2012 and June 1st, 2015 served as controls. They received standard care by a rheumatologist. The Danish guidelines for managing PMR remained unchanged throughout the study period. The study population was identified by searching the electronic patient journal for the PMR diagnosis. Data collection was performed by four experienced reumatologists. Data were obtained from the Electronic Patient Journal of Central Denmark Region and recorded in the RedCap database. Results: Five hundred and seventy patients were screened. Patients not diagnosed with PMR, with simultaneously giant cell arteritis, with relapse of known PMR, or prednisolone treatment for more than 4 weeks prior to the diagnosis were excluded. Sixty eight patients received standard care and 107 nurse-led care. There was no statistical difference between groups regarding reason for exclusion. At baseline there was no difference between patients receiving standard care and nurse-led care regarding gender, mean age (70.7 years vs. 72.2 years), clinical findings, symptoms, level of C-reactive protein (43.4 mg/L vs. 39.7 mg/L), anti-citrullinated protein antibody and reumatoid factor status. Median (IQR) prednisolone starting dose in the standard care group was 15 mg (15-25) vs. 15 mg (15-15) in the nurse-led care group ( p =0.008). After 1 year 29.4% of patients receiving standard care had discontinued prednisolone vs. 35.5% receiving nurse-led care ( p =0.403). Median (IQR) prednisolone dose after 1 year was 3.75 mg (0-5) in the standard care group and 1.25 mg (0-3.75) in nurse-led care group ( p =0.004). After 2 years 60.3% of patients receiving standard had discontinued prednisolone vs. 82.2% receiving nurse-led care ( p =0.001). Median (IQR) prednisolone dose after 2 years was 0 mg (0-2.5) in the standard care group and 0 mg (0-0) in the nurse-led care group ( p =0.004). There was no difference between groups regarding relapse of PMR and initiation of MTX treatment in either year 1 or 2. Conclusion: A tight and systematic approach to prednisolone tapering in PMR is more effective than usual care. The results should be confirmed in a prospective setting. References: [1] Gabriel SE, Sunku J, Salvarani C, O’Fallon WM, Hunder GG. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum 1997; 40(10):1873-8. [2] Muratore F, Pipitone N, Hunder GG, Salvarani C. Discontinuation of therapies in polymyalgia rheumatica and giant cell arteritis. Clin Exp Rheumatol 2013; 31(4 Suppl 78):S86-92. Disclosure of Interests: None declared