RT Journal Article
SR Electronic
T1 Permanent Discontinuation of Glucocorticoids in Polymyalgia Rheumatica Is Uncommon but May Be Enhanced by Amino Bisphosphonates
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 318
OP 322
DO 10.3899/jrheum.180324
VO 46
IS 3
A1 Alessandro Giollo
A1 Maurizio Rossini
A1 Francesco Bettili
A1 Francesco Ghellere
A1 Elena Fracassi
A1 Luca Idolazzi
A1 Davide Gatti
A1 Ombretta Viapiana
YR 2019
UL http://www.jrheum.org/content/46/3/318.abstract
AB 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.