Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 2;6(1):45.
doi: 10.1186/s41927-022-00274-y.

(Dis)agreement of polymyalgia rheumatica relapse criteria, and prediction of relapse in a retrospective cohort

Thomas E Bolhuis  1   2 , Diane Marsman  3   4 , Frank H J van den Hoogen  3   5 , Alfons A den Broeder  3   5 , Nathan den Broeder  3   4 , Aatke van der Maas  3
Affiliations

(Dis)agreement of polymyalgia rheumatica relapse criteria, and prediction of relapse in a retrospective cohort

Thomas E Bolhuis et al. BMC Rheumatol. .

Abstract

Background: To develop and assess a prediction model for polymyalgia rheumatica (PMR) relapse within the first year of glucocorticoid (GC) treatment.

Methods: A retrospective PMR cohort (clinical diagnosis) from a rheumatology department was used. All visits > 30 days after starting GC treatment and with > 2.5 mg/day oral prednisolone were used as potential relapse visits. Often used relapse criteria (1) rheumatologist judgement, (2) treatment intensification-based relapse) were assessed for agreement in this cohort. The proportion of patients with treatment-based relapse within 1 and 2 years of treatment and the relapse incidence rate were used to assess unadjusted associations with candidate predictors using logistic and Poisson regression respectively. After using a multiple imputation method, a multivariable model was developed and assessed to predict the occurrence (yes/no) of relapse within the first year of treatment.

Results: Data from 417 patients was used. Relapse occurred at 399 and 321 (of 2422) visits based on the rheumatologist judgement- and treatment-based criteria respectively, with low to moderate agreement between the two (87% (95% CI 0.86-0.88), with κ = 0.49 (95% CI 0.44-0.54)). Treatment-based relapse within the first two years was significantly associated with CRP, ESR, and pre-treatment symptom duration, and incidence rate with only CRP and ESR. A model to predict treatment intensification within the first year of treatment was developed using sex, medical history of cardiovascular disease and malignancies, pre-treatment symptom duration, ESR, and Hb, with an AUC of 0.60-0.65.

Conclusion: PMR relapse occurs frequently, although commonly used criteria only show moderate agreement, underlining the importance of a uniform definition and criteria of a PMR specific relapse. A model to predict treatment intensification was developed using practical predictors, although its performance was modest.

Keywords: Epidemiology; Polymyalgia rheumatica; Prediction; Prognosis; Relapse; Risk factors.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patients and visits with a (potential) relapse based on rheumatologist judgement (RJ) and treatment intensification (TI)
See this image and copyright information in PMC

References

    1. González-Gay MA, Matteson EL, Castañeda S. Polymyalgia rheumatica. The Lancet. 2017;390(10103):1700–1712. doi: 10.1016/S0140-6736(17)31825-1. - DOI - PubMed
    1. Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, 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(10):1799–1807. doi: 10.1136/annrheumdis-2015-207492. - DOI - PubMed
    1. Hutchings A, Hollywood J, Lamping DL, Pease CT, Chakravarty K, Silverman B, et al. Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica. Arthritis Care Res. 2007;57(5):803–809. doi: 10.1002/art.22777. - DOI - PubMed
    1. Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE, et al. Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol. 2005;32(1):65–73. - PubMed
    1. Mackie SL, Hensor EMAA, Haugeberg G, Bhakta B, Pease CT. Can the prognosis of polymyalgia rheumatica be predicted at disease onset? Results from a 5-year prospective study. Rheumatology (Oxford) 2010;49(4):716–722. doi: 10.1093/rheumatology/kep395. - DOI - PubMed