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Seminars in Arthritis and Rheumatism Jun 2020We investigated the effectiveness of tocilizumab (an anti-interleukin-6 receptor antibody) in patients with polymyalgia rheumatica (PMR).
OBJECTIVE
We investigated the effectiveness of tocilizumab (an anti-interleukin-6 receptor antibody) in patients with polymyalgia rheumatica (PMR).
METHODS
We performed a systematic literature review from the inception dates until August 7, 2019 for articles reporting tocilizumab administration to treat isolated PMR.
RESULTS
We identified 59 patients with isolated PMR treated with tocilizumab. All studies used intravenously administered tocilizumab at a dose of 8 mg/kg monthly. Tocilizumab monotherapy was administered to 24 and combination therapy (tocilizumab + glucocorticoid) to 35 patients. Tocilizumab monotherapy achieved low disease activity scores in only 17% of patients at week 4 and in only 71% patients even at week 12. Compared to glucocorticoid monotherapy, the reduction in the cumulative glucocorticoid dose was between 58% and 70% using a combination of tocilizumab and glucocorticoids, and 33-100% of the patients eventually showed glucocorticoid-free remission. All relapses occurred in patients administered tocilizumab monotherapy. No new safety event was reported.
CONCLUSION
Tocilizumab is effective in cases of isolated PMR, particularly in combination with glucocorticoids. In addition to its glucocorticoid-sparing effect, it achieves glucocorticoid-free remission and reduces relapse rates. Tocilizumab monotherapy is not recommended.
Topics: Administration, Intravenous; Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized; Drug Administration Schedule; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Male; Middle Aged; Polymyalgia Rheumatica; Receptors, Interleukin-6; Secondary Prevention
PubMed: 32107035
DOI: 10.1016/j.semarthrit.2019.12.005 -
Zeitschrift Fur Rheumatologie Feb 2024This study aimed to update the prevalence estimates of inflammatory rheumatic diseases (IRD) in Germany.
OBJECTIVE
This study aimed to update the prevalence estimates of inflammatory rheumatic diseases (IRD) in Germany.
METHODS
A systematic literature search in PubMed and Web of Science (last search 08 November 2022) identified original articles (regional and nationwide surveys and claims data analyses for arthritides, connective tissue diseases, and vasculitides) on prevalences for the period 2014-2022. Data sources, collection period, case definition, and risk of bias are reported. Prevalences were estimated from available national data, with consideration of international data.
RESULTS
Screening by two authors yielded 263 hits, of which 18 claims data analyses and 2 surveys met the inclusion criteria. Prevalences ranged from 0.42 to 1.85% (rheumatoid arthritis), 0.32-0.5% (ankylosing spondylitis), 0.11-0.32% (psoriatic arthritis), 0.037-0.14% (systemic lupus erythematosus), 0.07-0.77% (Sjögren's disease/sicca syndrome), 0.14-0.15% (polymyalgia rheumatica, ≥ 40 years), 0.04-0.05% (giant cell arteritis, ≥ 50 years), and 0.015-0.026% (ANCA-associated vasculitis). The risk of bias was moderate in 13 and high in 7 studies. Based on the results, we estimate the prevalence of IRD in Germany to be 2.2-3.0%, which corresponds to approximately 1.5-2.1 million affected individuals. The prevalence of juvenile idiopathic arthritis was reported to be around 0.10% (0.07-0.10%) of 0-18-year-olds, corresponding to about 14,000 children and adolescents in Germany.
CONCLUSION
This systematic review shows an increase in the prevalence of IRD in Germany, which is almost exclusively based on claims data analyses. In the absence of multistage population studies, the available data are, overall, uncertain sources for prevalence estimates, with a moderate to high risk of bias.
Topics: Child; Adolescent; Humans; Prevalence; Arthritis, Rheumatoid; Spondylitis, Ankylosing; Polymyalgia Rheumatica; Sjogren's Syndrome; Lupus Erythematosus, Systemic; Rheumatic Fever; Giant Cell Arteritis; Rheumatic Diseases
PubMed: 36749363
DOI: 10.1007/s00393-022-01302-5 -
Medicines (Basel, Switzerland) Nov 2020: Polymyalgia Rheumatica (PMR) is one of the most frequent rheumatologic immune-related adverse effects (IRAEs) in cancer patients following therapy with immune... (Review)
Review
Identification and Classification of Polymyalgia Rheumatica (PMR) and PMR-Like Syndromes Following Immune Checkpoint Inhibitors (ICIs) Therapy: Discussion Points and Grey Areas Emerging from a Systematic Review of Published Literature.
: Polymyalgia Rheumatica (PMR) is one of the most frequent rheumatologic immune-related adverse effects (IRAEs) in cancer patients following therapy with immune checkpoint inhibitors (ICIs). Atypical findings in many patients often lead to diagnosing PMR-like syndromes. : The aim of our research was to review reported diagnoses of PMR and PMR-like syndromes following ICIs therapy, and assess whether they can be redefined as adverse drug reaction (ADR). In line with PRISMA guidelines, we carried out a systematic search on three main bibliographic databases, based on a combination of subject headings and free text. We included all studies and case-reports published after 2011 (when FDA approved the use of the first ICI) describing the association of PMR or PMR-like syndromes with all types of ICIs therapy. We excluded reviews, conference abstracts, comments, secondary articles, and non-English language studies. : We reviewed data from seven studies and eight case-reports, involving a total of 54 patients. Limitations included: the small size of all studies; only one retrospective study used validated criteria for PMR; most reports assessed IRAEs by clinical judgment only and did not seek validation through assessment scales. To date, it remains a conundrum whether IRAEs-PMR is identical to the idiopathic form of the disease, or whether it should be considered a subset of the disease or a new entity. Our review indicates that the relationship between PMR and ICIs therapy is yet to be clearly understood and defined and that future research should remedy the current limits in study design.
PubMed: 33153016
DOI: 10.3390/medicines7110068 -
Annals of the Rheumatic Diseases Oct 2015To summarise evidence on therapeutic interventions and prognostic factors in polymyalgia rheumatica (PMR). A systematic literature review was conducted using Ovid... (Review)
Review
Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica: a systematic literature review informing the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for the management of polymyalgia rheumatica.
To summarise evidence on therapeutic interventions and prognostic factors in polymyalgia rheumatica (PMR). A systematic literature review was conducted using Ovid Medline, Embase, PubMed, CINAHL, Web of Science and the Cochrane Library (1970 through April 2014). Quality of evidence (QoE) of identified studies was appraised by Grading of Recommendations Assessment, Development and Evaluation (GRADE) (interventions) and the Quality In Prognosis Studies (QUIPS) methodologies (prognostic factors). Out of 10 931 titles identified, 52 articles were finally selected. A single study indicated that an initial prednisone dose of 20 mg/day is associated with a lower short-term relapse rate than 10 mg/day but at the cost of a higher rate of adverse events. Another study suggested a comparable efficacy of intramuscular methylprednisolone and oral glucocorticoids (GCs) with lower cumulative GC doses and less weight gain in the former group. Moderate to high QoE (1-2 studies) indicated a benefit of methotrexate in remission rates and cumulative GC doses in early PMR. Anti-tumour necrosis factor α agents are ineffective for PMR treatment. Among prognostic factors, female sex, high erythrocyte sedimentation rate (ESR) and peripheral arthritis were associated in some studies with a higher relapse risk. Women and patients with high ESR also appeared to have a longer duration of treatment. Several studies of varying quality, however, failed to prove these associations. In PMR, evidence for initial GC doses and subsequent tapering regimens is limited. Intramuscular methylprednisolone and methotrexate may be effective GC sparing agents. Female sex, high ESR and peripheral arthritis at disease outset are potential risk factors for a worse prognosis.
Topics: Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Dose-Response Relationship, Drug; Drug Administration Schedule; Evidence-Based Medicine; Glucocorticoids; Humans; Injections, Intramuscular; Polymyalgia Rheumatica; Practice Guidelines as Topic; Prognosis; Risk Factors
PubMed: 26359489
DOI: 10.1136/annrheumdis-2015-207578 -
The Journal of Rheumatology Jun 2021To systematically identify the outcome measures and instruments used in clinical studies of polymyalgia rheumatica (PMR) and to evaluate evidence about their measurement...
OBJECTIVE
To systematically identify the outcome measures and instruments used in clinical studies of polymyalgia rheumatica (PMR) and to evaluate evidence about their measurement properties.
METHODS
Searches based on the MeSH term "polymyalgia rheumatica" were carried out in 5 databases. Two researchers were involved in screening, data extraction, and risk of bias assessment. Once outcomes and instruments used were identified and categorized, key instruments were selected for further review through a consensus process. Studies on measurement properties of these instruments were appraised against the COSMIN-OMERACT (COnsensus-based Standards for the selection of health Measurement Instruments-Outcome Measures in Rheumatology) checklist to determine the extent of evidence supporting their use in PMR.
RESULTS
Forty-six studies were included. In decreasing order of frequency, the most common outcomes (and instruments) used were markers of systemic inflammation [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)], pain [visual analog scale (VAS)], stiffness (duration in minutes), and physical function (elevation of upper limbs). Instruments selected for further evaluation were ESR, CRP, pain VAS, morning stiffness duration, and the Health Assessment Questionnaire. Five studies evaluated measurement properties of these instruments, but none met all of the COSMIN-OMERACT checklist criteria.
CONCLUSION
Measurement of outcomes in studies of PMR lacks consistency. The critical patient-centered domain of physical function is poorly assessed. None of the candidate instruments considered for inclusion in the core outcome set had high-quality evidence, derived from populations with PMR, on their full range of measurement properties. Further studies are needed to determine whether these instruments are suitable for inclusion in a core outcome measurement set for PMR.
Topics: Blood Sedimentation; Humans; Outcome Assessment, Health Care; Pain Measurement; Polymyalgia Rheumatica; Visual Analog Scale
PubMed: 32739892
DOI: 10.3899/jrheum.200248 -
Rheumatology International Jul 2016Patient-reported outcomes (PROs) are being increasingly recognized as important measures by rheumatologists. The objective of this review was to evaluate the frequency... (Review)
Review
Patient-reported outcomes (PROs) are being increasingly recognized as important measures by rheumatologists. The objective of this review was to evaluate the frequency of use of PROs in studies of patients with polymyalgia rheumatica (PMR). A systematic literature search was performed in PubMed (up to April 2015) to identify any type of clinical studies reporting any type of PROs in patients with PMR. Articles were excluded if they did not include adults with PMR or did not report any PROs. Characteristics of each study such as study design, follow-up, treatment assessed if any, number of patients, mean age, gender, and a description of PROs used were collected to perform a descriptive analysis. From 118 initial studies captured, 28 articles met the predefined criteria, and 20 were finally included in this review. Ten studies (50 %) were randomized clinical trials (RCTs), and 8 (40 %) were cohorts. The most frequently reported domains were: pain (90 %), being the most frequent tool using a visual analogue scale; morning stiffness in minutes (85 %); and function (25 %), evaluated through the Health Assessment Questionnaire. Other domains such as patient global assessment, fatigue, quality of life, and anxiety and depression were infrequently reported. A larger proportion of PROs were included in cohorts in comparison with RCT. Pain and morning stiffness are the most frequently reported PROs. Other domains that may appear relevant for patients are infrequently reported, especially function.
Topics: Clinical Trials as Topic; Disability Evaluation; Health Status; Health Status Indicators; Humans; Mental Health; Pain Measurement; Patient Reported Outcome Measures; Polymyalgia Rheumatica; Predictive Value of Tests; Psychiatric Status Rating Scales; Quality of Life; Recovery of Function; Remission Induction; Treatment Outcome
PubMed: 26769433
DOI: 10.1007/s00296-015-3416-9 -
Seminars in Arthritis and Rheumatism Dec 2014To investigate the association between giant cell arteritis (GCA)/polymyalgia rheumatica (PMR) and malignancy risk. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the association between giant cell arteritis (GCA)/polymyalgia rheumatica (PMR) and malignancy risk.
METHODS
We conducted a systematic review and meta-analysis of cohort studies that reported relative risk, hazard ratio, or standardized incidence ratio (SIRs) with 95% confidence comparing malignancy risk in patients with GCA/PMR versus non-GCA/PMR participants. Pooled risk ratios and 95% confidence intervals were calculated using a random-effect, generic inverse variance method.
RESULT
A total of six studies were identified and included in our data analysis. The pooled risk ratio of malignancy in patients with GCA/PMR was 1.14 (95% CI: 1.05-1.22). The risk was higher in the first 6-12 months after diagnosis with the pooled risk ratio of 2.16 (95% CI: 1.85-2.53). However, when we performed a sensitivity analysis that excluded one study with a potential selection bias, the pooled risk ratio decreased and did not achieve statistical significance.
CONCLUSION
Our study demonstrated a low but statistically significant increased malignancy risk among patients with GCA/PMR. However, when we excluded one study with potential selection bias, the new pooled risk ratio did not achieve statistical significance.
Topics: Giant Cell Arteritis; Humans; Incidence; Neoplasms; Polymyalgia Rheumatica; Risk Factors
PubMed: 25074657
DOI: 10.1016/j.semarthrit.2014.06.004 -
BMC Musculoskeletal Disorders Jun 2015Gait analysis is increasingly being used to characterise dysfunction of the lower limb and foot in people with inflammatory arthritis (IA). The aim of the systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Gait analysis is increasingly being used to characterise dysfunction of the lower limb and foot in people with inflammatory arthritis (IA). The aim of the systematic review was to evaluate the spatiotemporal, foot and ankle kinematic, kinetic, peak plantar pressure and muscle activity parameters between patients with inflammatory arthritis and healthy controls.
METHODS
An electronic literature search was performed on Medline, CINAHL, SportsDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Effect sizes with 95% confidence intervals (CI) were calculated as the standardised mean difference (SMD). Meta-analysis was conducted if studies were homogenous.
RESULTS
Thirty six studies with quality ranging from high to low met the inclusion criteria. The majority of studies reported gait parameters in Rheumatoid arthritis (RA). The gait pattern in RA was characterised by decreased walking speed (SMD 95% CI -1.57, -2.25 to -0.89), decreased cadence (SMD -0.97, -1.49 to -0.45), decreased stride length (SMD -1.66, -1.84 to -1.49), decreased ankle power (SMD -1.36, -1.70 to -1.02), increased double limb support time (SMD 1.03, 0.84 to 1.22), and peak plantar pressures at the forefoot (SMD 1.11, 0.76 to 1.45). Walking velocity was reduced in psoriatic arthritis and gout with no differences in ankylosing spondylitis. No studies have been conducted in polymyalgia rheumatica, systemic sclerosis or systemic lupus erythematosus.
CONCLUSIONS
The review identified the majority of studies reporting gait adaptations in RA, but limited evidence relating to other IA conditions. Poor data reporting, small sample sizes and heterogeneity across IA conditions limit the interpretation of the findings. Future studies may consider a standardised analytical approach to gait analysis that will provide clinicians and researchers with objective evidence of foot function in people with IA.
Topics: Ankle; Arthritis; Biomechanical Phenomena; Foot; Gait; Humans; Kinetics; Muscle, Skeletal; Pressure
PubMed: 26044780
DOI: 10.1186/s12891-015-0596-0 -
Frontiers in Neurology 2022Several studies showed inconsistencies in the relationships between inflammatory rheumatic diseases (IRDs) and the risk of Parkinson's disease (PD). Therefore, we...
BACKGROUND
Several studies showed inconsistencies in the relationships between inflammatory rheumatic diseases (IRDs) and the risk of Parkinson's disease (PD). Therefore, we carried out a meta-analysis to investigate the associations between different IRDs and PD risk.
METHODS
A comprehensive search was undertaken on PubMed, Embase, Cochrane Library, and Web of Science databases up to June 2022. Studies reporting the relationships between IRDs and PD risk were included. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated by using random-effects models.
RESULTS
Twenty-two publications covering seven IRDs containing data from 833,004 patients were identified for quantitative analysis. The pooled results indicated that ankylosing spondylitis (RR = 1.55, 95% CI: 1.31-1.83, I = 32.1%, < 0.001), Sjögren's syndrome (RR = 1.34, 95% CI: 1.22-1.47, I = 58.5%, < 0.001), and Behcet's disease (RR = 1.93, 95% CI: 1.07-3.49, I = 57.6%, = 0.030) were associated with an increased PD risk. However, no significant associations were observed between gout, rheumatoid arthritis, systemic lupus erythematosus, as well as polymyalgia rheumatica and the subsequent development of PD.
CONCLUSION
Ankylosing spondylitis, Sjögren's syndrome, and Behcet's disease may increase PD risk.
PubMed: 36438950
DOI: 10.3389/fneur.2022.999820 -
Journal of Clinical Rheumatology :... Jan 2021Giant cell arteritis (GCA) is a systemic vasculitis that commonly co-occurs with polymyalgia rheumatica (PMR) in elderly patients. Pericardial disease is an unusual...
BACKGROUND
Giant cell arteritis (GCA) is a systemic vasculitis that commonly co-occurs with polymyalgia rheumatica (PMR) in elderly patients. Pericardial disease is an unusual manifestation of these inflammatory conditions, which has been reported only in case reports and small observational studies. However, no extensive research has been performed to study the demographics and clinical history of GCA or PMR patients with concomitant pericardial features. As a result, the medical evidence to help guide the physicians when evaluating such individuals is limited.
OBJECTIVE
To perform a systematic review of the medical literature in order to summarize the epidemiological and clinicopathological aspects of this unique association.
METHODS
We conducted an extensive search of PubMed, Cochrane Library, Ovid, Google Scholar, and gray literature to identify all the cases of GCA and PMR with pericardial involvement. The demographics, clinical features, and outcomes of the final cohort were reviewed and analyzed.
RESULTS
The analysis comprised 52 clinical cases (51 identified from 46 articles and 1 from the residents' clinic). These included 44 patients with GCA and 8 with PMR. The mean age at presentation was 69.5 years, with only 46% of patients older than 70 years. The most common abnormality was pericardial effusion (85%), and in 37%, the pericardial event was the initial disease manifestation. Although a significant proportion of the patients were symptomatic (69%), the classic cranial symptoms were present in only 40%. Overall, the outcome was good even in the presence of large-vessel disease, which is usually a poor prognostic factor in classic GCA. On group analysis, patients with PMR were more likely to develop cardiac tamponade (37.5%; odds ratio, 25.8; confidence interval, 2.2-297.5; p = 0.01), whereas those with GCA were more likely to have large-vessel vasculitis (43%; odds ratio, 5.18; confidence interval, 0.58-252.1; p = 0.04).
CONCLUSIONS
This study illustrates that patients with pericardial involvement represent a clinical phenotype of GCA (and possibly PMR), which is quite different from the cranial or large-vessel forms. These patients have a better prognosis likely due to younger age and presence of more overt symptoms resulting in early diagnosis.
Topics: Giant Cell Arteritis; Humans; Pericardial Effusion; Pericardium; Polymyalgia Rheumatica; Prognosis
PubMed: 31483352
DOI: 10.1097/RHU.0000000000001140