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Research ArticleOther Arthritides

Permanent Discontinuation of Glucocorticoids in Polymyalgia Rheumatica Is Uncommon but May Be Enhanced by Amino Bisphosphonates

Alessandro Giollo, Maurizio Rossini, Francesco Bettili, Francesco Ghellere, Elena Fracassi, Luca Idolazzi, Davide Gatti and Ombretta Viapiana
The Journal of Rheumatology March 2019, 46 (3) 318-322; DOI: https://doi.org/10.3899/jrheum.180324
Alessandro Giollo
From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.
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  • For correspondence: alessandrogiollo@gmail.com
Maurizio Rossini
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Francesco Bettili
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Francesco Ghellere
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Elena Fracassi
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Luca Idolazzi
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Davide Gatti
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Ombretta Viapiana
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Abstract

Objective. The duration of treatment with glucocorticoids (GC) in polymyalgia rheumatica (PMR) is often longterm. Amino bisphosphonates (N-BP) are used in PMR for the prevention of GC-induced osteoporosis, but they coulsd also have immunomodulatory properties. Whether they can be effective as an adjuvant treatment in PMR is unknown. We aimed to establish whether the use of N-BP in our PMR cohort may be associated with GC discontinuation.

Methods. We conducted a retrospective review of all patients diagnosed with PMR recorded in our electronic medical notes. Cox regression analyses were used to examine the association between the use of N-BP and discontinuation of GC.

Results. Data were retrieved for 385 patients (mean age 71 ± 10 yrs, 64% females, mean initial prednisone dose 19 ± 9 mg/day). The median followup time was 38 months (range 9–57); more than 60% of patients were exposed to N-BP. GC were discontinued in 47% of patients after a median time of 20 months (range 14–27), but subsequently restarted in 39%. Overall, 276/385 patients (72%) were actively treated at their last available evaluation (mean prednisone dose 4.9 ± 5.5 mg/day), while 123/205 (60%) were still receiving GC after 24 months of followup. The use of N-BP was associated with the discontinuation of GC (adjusted HR 0.66, 95% CI 0.50–0.88), independent of age, initial GC dose, and osteoporosis.

Conclusion. Unlike current guidelines, longterm treatment with GC is often necessary. These preliminary data suggest that N-BP may be involved in the management of PMR.

Key Indexing Terms:
  • POLYMYALGIA RHEUMATICA
  • BISPHOSPHONATE
  • GLUCOCORTICOIDS
  • OSTEOPOROSIS
  • Accepted for publication August 8, 2018.
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The Journal of Rheumatology
Vol. 46, Issue 3
1 Mar 2019
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Permanent Discontinuation of Glucocorticoids in Polymyalgia Rheumatica Is Uncommon but May Be Enhanced by Amino Bisphosphonates
Alessandro Giollo, Maurizio Rossini, Francesco Bettili, Francesco Ghellere, Elena Fracassi, Luca Idolazzi, Davide Gatti, Ombretta Viapiana
The Journal of Rheumatology Mar 2019, 46 (3) 318-322; DOI: 10.3899/jrheum.180324

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Permanent Discontinuation of Glucocorticoids in Polymyalgia Rheumatica Is Uncommon but May Be Enhanced by Amino Bisphosphonates
Alessandro Giollo, Maurizio Rossini, Francesco Bettili, Francesco Ghellere, Elena Fracassi, Luca Idolazzi, Davide Gatti, Ombretta Viapiana
The Journal of Rheumatology Mar 2019, 46 (3) 318-322; DOI: 10.3899/jrheum.180324
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Keywords

POLYMYALGIA RHEUMATICA
BISPHOSPHONATE
GLUCOCORTICOIDS
OSTEOPOROSIS

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