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. 2025 Jul 21;27(1):154.
doi: 10.1186/s13075-025-03613-9.

Mortality in polymyalgia rheumatica: a 38-year prospective population-based cohort study from Southern Norway

Stig Tengesdal  1   2   3 , Øyvind Molberg  4   5 , Øyvind Holme  6   7 , Jan Tore Gran  4   5 , Geirmund Myklebust  6
Affiliations

Mortality in polymyalgia rheumatica: a 38-year prospective population-based cohort study from Southern Norway

Stig Tengesdal et al. Arthritis Res Ther. .

Abstract

Background: Robust long-term mortality data on patients with polymyalgia rheumatica (PMR) are lacking. The aim of this study was to determine all-cause mortality in isolated PMR using a large, population-based, inception cohort followed prospectively over a 38-year period.

Methods: Between 1987 and 1997, 337 incident cases of PMR and biopsy-proven GCA were included in a prospective, population-based inception cohort in Aust-Agder County, Norway. Diagnosis was ascertained clinically by a rheumatologist, with PMR cases meeting Bird`s criteria. Patients were followed until death or end of study on December 31st, 2024. Each case was matched by gender, age at inclusion, and residency with 15 population comparators drawn from the population registry in Norway. We assessed mortality and survival by standard mortality ratios (SMR) and the Kaplan-Meier method.

Results: A total of 274 patients with isolated PMR (66.1% female, mean age at diagnosis 71.9 years) and 63 patients with GCA (76.2% female, mean age at diagnosis 71.6 years) were included. By the end of the study, 96.4% of all patients were deceased. Mean follow-up time for all patients was 13.7 years, with a maximum of 35.3 years. For cases with isolated PMR, the overall SMR was 0.97 (95% confidence interval [CI] 0.85, 1.09), for men 0.77 (95% CI 0.62, 0.95), and for women 1.11 (95% CI 0.95, 1.28). For GCA, the overall SMR was 1.10 (95% CI 0.85, 1.40), with no gender difference.

Conclusions: In this comprehensive long-term follow-up study with nearly complete data on mortality, isolated PMR was not associated with increased mortality, reinforcing the view that it does not confer a higher mortality risk.

Keywords: Epidemiology; Giant cell arteritis; Mortality; Polymyalgia rheumatica; Survival.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study complies with the Declaration of Helsinki and was approved by the regional ethics committee with exemption from informed consent for identifications of patients and linkage to the NPR (Case number 45964, November 14, 2019). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart illustrating relationships between the original project cohort and incident PMR and GCA cohorts studied
Fig. 2
Fig. 2
Forest plot of SMRs for new-onset PMR or GCA compared with the matched comparators. Abbreviations: SMR: standard mortality ratios; N: number of patients; Observed: number of deaths in the PMR and GCA patient cohorts; Expected: number of expected deaths estimated from the total number of deaths observed in the age-, gender and residency-matched population comparator group
Fig. 3
Fig. 3
Forest plot of SMRs across the observation period in the prospective PMR cohort. Data are expressed as years of follow-up from diagnosis of PMR. Abbreviations: SMR: standard mortality ratios; N: number of patients; Observed: cumulative number of deaths in the PMR patient cohort at the defined follow-up times. Expected: cumulative number of expected deaths in the in age-, gender and residency-matched population comparator group, estimated from total number of deaths observed in this group at the different lengths of follow-up
Fig. 4
Fig. 4
Kaplan-Meier survival curves for patients with new-onset PMR compared to matched comparators. Legend: (A) All patients, (B) Men, and (C) Women
Fig. 5
Fig. 5
Kaplan-Meier survival curves for patients with new-onset GCA compared to matched comparators. Legend: (A) All patients, (B) Men, and (C) Women
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