Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Patient-Reported Outcome Measures in Patients with Polymyalgia Rheumatica (PMR): Results from an International, Prospective, Multi-Centre Study. ACR EULAR Study Group for Development of Classification Criteria for PMR.

Dasgupta16,  Bhaskar, Cimmino10,  Marco A., Maradit-Kremers3,  Hilal, Schmidt19,  Wolfgang A., Michael5,  Schirmer, Salvarani11,  Carlo, Mandl20,  Peter

3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest
Department of Internal Medicine, University of Genova, Genova, Italy
Department of Rheumatology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
Department of Rheumatology, Cambridge University, Cambridge, UK
Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
Department of Rheumatology, Medical University, Graz, Graz, Austria
Department of Rheumatology, Princess Alexandra Hospital, Harlow, United Kingdom
Department of Rheumatology, Southend University Hospital, Essex, United Kingdom
Department of Systemic Autoimmune Hospital Clinic Provincial, Barcelona, Spain
Gentofte Hospital, Rheumatology Division, Hellerup, Denmark
Immanuel Krankenhaus Berlin: Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany
Center for Diagnosis Imaging, Hospital Clínic, Montserrat del Amo, Barcelona, Spain
National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
Rheumatology Associates of North Jersey, Teaneck, NJ
Rheumatology Unit, Clinica e Terapia Medica Department, Sapienza Università di Roma, Policlinico Umberto I, Rome, Italy
Rheumatology Unit, Ospedale Misericordia e Dolce, Prato, Italy
Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
Service de Medecine Interne, Amiens, France
Servicio de Reumatología, Hospital Universitario Marques de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
Department of Health Sciences Research, Mayo Clinic, Rochester, MN
Department of Internal Medicine and Rheumatology, WIM CSK MON, Warszawa, Poland
Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria
Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Jacksonville, FL
Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN
Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Scottsdale, AZ
Department of Internal Medicine, General Hospital of the Elisabethinen, Klagenfurt, Austria

Objective:

To evaluate the disease course and performance of patient-reported outcome measures in patients with polymyalgia rheumatica (PMR)

Methods:

The study population included 88 patients with new onset PMR who were initially treated with prednisolone/prednisone dose of 15 mg daily tapered gradually, and assessed at baseline and weeks 1, 4, 12 and 26 following start of steroid therapy. Data were collected on personal and family history, clinical signs and symptoms, laboratory results, treatment details, ultrasound evaluation of shoulders and hip, disability (MHAQ), quality of life (SF36), and patient reported outcomes (PRO) of global pain, PMR pain, shoulder pain and fatigue obtained using visual analog scales (VAS). Complete response to treatment was defined as >=70% improvement from baseline on patient report of shoulder pain by VAS at each study visit. Spearman methods were used to assess correlations between improvement measures.

Results:

At initial presentation, 99% patients had shoulder pain, 70% had hip pain and 96% had abnormal c-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). Median duration of morning stiffness was 120 minutes with median MHAQ 1.1, median global VAS 65, PMR VAS 69 and fatigue VAS 60. Within 4 weeks, all PRO parameters improved dramatically (>= 70% improvement) in majority of the patients (72% of patients for global VAS, 80% for PMR VAS and 60% for fatigue VAS); median change in MHAQ at 4 weeks was -0.875. Median change at 26 weeks was -0.94. Similarly, 62% of patients had normal CRP/ESR values at 4 weeks. However, few additional patients showed improvement from 4 weeks to 26 weeks. Complete steroid response at 4 weeks was seen in 70% of patients and the response was sustained in 85% of responders at 26 weeks. As planned, the median prednisone dose decreased from 15 mg at baseline to 5.5 mg at 26 weeks. Response to treatment (% improvement in shoulder pain VAS at weeks 4 and 26) was highly correlated with % improvement in other VAS measures (correlation>0.55 and p<0.001 at weeks 4 and 26) and % change in ESR (p<0.001 at week 4 and p=0.04 at week 26), but weakly correlated with % change in CRP (p=0.07 at week 4 and p=0.30 at week 26) and change in steroid dose (p=0.39 at week 4 and p=0.04 at week 26).

Conclusions:

PRO measures including MHAQ, global, PMR and fatigue VAS, and inflammatory markers performed well in assessing disease activity in patients with PMR. Percent improvement in PRO measures were highly correlated with each other, but ESR and CRP correlated less strongly. We suggest that a minimum set of outcome measures consisting of PROs of shoulder pain and function and an inflammatory marker be used in practice and clinical trials in PMR.

To cite this abstract, please use the following information:
Dasgupta, Bhaskar, Cimmino, Marco A., Maradit-Kremers, Hilal, Schmidt, Wolfgang A., Michael, Schirmer, Salvarani, Carlo, et al; Patient-Reported Outcome Measures in Patients with Polymyalgia Rheumatica (PMR): Results from an International, Prospective, Multi-Centre Study. ACR EULAR Study Group for Development of Classification Criteria for PMR. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :777
DOI: 10.1002/art.28545

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