Abstract
To update community-based prevalence values for Polymyalgia Rheumatic (PMR) and Giant Cell Arteritis (GCA) using case record review supplemented by population survey and subsequent clinical review. Clinical data were obtained from case records of a large primary care practice in Norfolk, UK and reviewed for diagnoses of GCA and PMR. In addition postal survey was carried out to capture potentially undiagnosed cases within the practice population. Those screening positive for potential diagnoses of GCA and PMR were invited for clinical review. A cumulative prevalence estimate was subsequently calculated on those diagnosed within the GP practice and subsequently on those fulfilling the various published classification criteria sets. The date of the database lock and mail merge was March 2013. Through detailed systematic review of 5,159 GP case records, 21 patients had a recorded diagnosis of GCA and 117 had PMR.No new cases were identified among 2,227 completed questionnaires returned from the population survey of a sample of 4,728. The resulting cumulative prevalence estimate in those aged ≥ 55 years meeting the ACR classification criteria set for GCA was 0.25 % (95 % CI 0.11 to 0.39 %) and for five published criteria sets for PMR ranged from 0.91 to 1.53 % (95 % CI ranges 0.65 %, 1.87 %). The prevalence of both conditions was higher in women than in men and in older age groups. This study provides the first UK prevalence estimate of GCA and PMR in over 30 years and is the first to apply classification criteria sets.
Highlights
To update community-based prevalence values for Polymyalgia Rheumatic (PMR) and Giant Cell Arteritis (GCA) using case record review supplemented by population survey and subsequent clinical review
Survey Subsequently, questionnaires were sent to 4,728 eligible patients of the 5,159 registered with the practice to ascertain any missed diagnoses of GCA and PMR not recorded in the general practitioner (GP) electronic register
A major strength of the study was that every effort has been made to ascertain cases of GCA and PMR which may have not been known to the GP practice
Summary
To update community-based prevalence values for Polymyalgia Rheumatic (PMR) and Giant Cell Arteritis (GCA) using case record review supplemented by population survey and subsequent clinical review. Polymyalgia rheumatica (PMR) is an inflammatory condition of unknown aetiology causing pain and stiffness in the shoulder and hip girdle [3, 4] Both conditions overlap and are rarely diagnosed in individuals under 50 years of age, with older age being part of many of the classification criteria sets for both diseases. The Kyle et al study pre-dates the current ACR classification criteria set and failed to include participants younger than 65 years Both conditions are commoner in older age groups and the lifeexpectancy of the UK population is increasing [6]. Data from the Mayo clinic from all incident cases of GCA from Olmsted County (years 1950 to 1999), revealed 173 cases of GCA in those aged ≥ 50 years This resulted in a prevalence estimate for GCA of 0.23 % and for PMR of 0.74 % (95 % CI 0.67 to 0.81) [7,8,9]. Data from Germany from a questionnaire sent to hospital departments and insurance companies in 2006
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