Increased risk of peripheral arterial disease in polymyalgia rheumatica: a population-based cohort study

Kenneth J Warrington,Gene G Hunder,Leslie T Cooper,Elena P Jarpa,Eric L Matteson,Cynthia S Crowson,Sherine E Gabriel

doi:10.1186/ar2664

Kenneth J Warrington, Gene G Hunder + Show 5 more

Open Access

https://doi.org/10.1186/ar2664

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Journal: Arthritis research & therapy	Publication Date: Jan 1, 2009
Citations: 62	License type: cc-by

Affiliation: Mayo Clinic

Abstract

IntroductionThe present study was conducted to determine whether patients with polymyalgia rheumatica (PMR) are at an increased risk of peripheral arterial disease (PAD).MethodsAn inception cohort of all Olmsted County, Minnesota residents diagnosed with PMR between 1 January 1970 and 31 December 1999 was compared with non-PMR subjects (two for each PMR subject) from among residents. Both cohorts were followed longitudinally by complete medical record review from the incidence date of PMR (or index date for the non-PMR cohort) until death, incident PAD, migration, or 31 December 2006. PMR-related disease characteristics, traditional cardiovascular risk factors and diagnosis of PAD were abstracted from the medical record. Cumulative incidence of PAD was estimated using Kaplan–Meier methods. Cox proportional hazards models were used to assess the risk of PAD in PMR compared with non-PMR.ResultsA total of 353 PMR patients (mean age 73.3 years, 67% women) and 705 non-PMR subjects (mean age 73.2 years, 68% female) were followed for a median of 11.0 years. PAD developed in 38 patients (10-year cumulative incidence, 8.5%) with PMR and in 28 non-PMR subjects (10-year cumulative incidence, 4.1%) (hazard ratio (95% confidence interval), 2.40 (1.47, 3.92)). After adjusting for traditional cardiovascular risk factors, patients with PMR still had a significantly higher risk for PAD (hazard ratio, 2.50 (1.53, 4.08)) compared with controls. Giant cell arteritis occurred in 63 (18%) PMR patients but was not predictive of PAD (P = 0.15). There was no difference between mortality in PMR and the non-PMR cohorts nor in PMR patients with and those without PAD (P = 0.16).ConclusionsPatients with PMR appear to have an increased risk of PAD.

Highlights

The present study was conducted to determine whether patients with polymyalgia rheumatica (PMR) are at an increased risk of peripheral arterial disease (PAD)
PAD developed in 38 patients (10-year cumulative incidence, 8.5%) with PMR and in 28 non-PMR subjects (10-year cumulative incidence, 4.1%) (hazard ratio (95% confidence interval), 2.40 (1.47, 3.92))
There was no difference between mortality in PMR and the nonPMR cohorts nor in PMR patients with and those without PAD (P = 0.16)

Summary

Introduction

The present study was conducted to determine whether patients with polymyalgia rheumatica (PMR) are at an increased risk of peripheral arterial disease (PAD). Polymyalgia rheumatica (PMR) is an inflammatory condition affecting middle-aged and older persons that is characterized by aching and stiffness, typically in the cervical region, shoulders, hips and proximal extremities. Most patients with PMR have laboratory evidence of an acute phase response, including elevation of the erythrocyte sedimentation rate and C-reactive protein (CRP). 16 to 21% of patients with PMR develop giant cell arteritis (GCA), an inflammatory vasculopathy that affects large and medium-size arteries. PMR is characteristically very responsive to treatment with corticosteroids; some patients have a chronic, relapsing course that lasts for several years [5]

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