AB1207 RISK FACTORS FOR HIGHER RELAPSE RATE AND/OR PROLONGED GLUCOCORTICOID THERAPY IN POLYMYALGIA RHEUMATICA: MULTICENTRE STUDY IN 185 PATIENTS

Abstract

BackgroundGlucocorticoids (GC) are the therapeutic mainstay in polymyalgia rheumatica (PMR). However, their adverse effects are of particular concern in elderly patients. Relapses and long-term GC dependency are common.ObjectivesAssess the risk factors for higher relapse rate and/or prolonged glucocorticoid therapy in 185 PMR patients from Argentina.MethodsA multicenter observational study of PMR patients diagnosed according to the Chuang criteria seen at the outpatient clinics at 12 public or private rheumatology units from Argentina between 2006 and 2021 was performed. Patients were followed until permanent remission, lost to follow up, or a maximum of 2 years after diagnosis. Relapse was defined as an exacerbation of PMR symptoms requiring an adjustment of GC dose (≥ 4 mg) occurring at least 1 month after diagnosis. Time to relapse was modeled using the Kaplan-Meier method. Cox regression models were used to evaluate predictors of time to first and subsequent relapses.ResultsA total of 185 patients were included (69.1% female) with a median age of 71 years (IQR 65-78 years). The median follow-up time was 17.1 months (IQR 6.8-34.7) and the incidence of relapses was 1.2 per 100 persons/month. The median time to relapse was 70.5 months (25th percentile = 14 months). Pain and/or stiffness in shoulder girdle and pelvic girdle together more common (p = 0.02) in the clinical presentation of patients who relapsed. In univariate analysis, PMR patients with a previous history of dyslipidemia had a lower risk of relapse (HR = 0.55, 95% CI = 0.33-0.94, p = 0.03). Laboratory at time of diagnosis showed that an ESR > 50 mm was found as a risk factor for relapse (HR = 2.50, 95% CI = 1.23-5.10, p = 0.011). Regarding therapy, meprednisone (HR = 2.38, 95% CI = 1.31-4.31, p = 0.004) and high dose GC (HR = 2.35, 95% CI = 1.42-3.87, p = 0.001) had higher risk of relapse. In multivariate analysis, only meprednisone (HR = 2.59, 95% CI = 1.28-5.23, p = 0.008) and high dose of GC (HR = 2.41, 95% CI = 1.19-4.89, p = 0.014) remained the only risk factors for relapse.ConclusionA lower relapse rate than that reported in the literature was observed. Meprednisone and high dose of GC are significant predictors of future relapses. Our results suggest that efforts should be made to minimize initial GC dose and avoid the use of meprednisone as GC of first choice in order to prevent disease relapses.Disclosure of InterestsNone declared