Abstract
ObjectivesThis study aimed to investigate the hospitalisation rates and the reasons for hospitalisation in patients with polymyalgia rheumatica (PMR). Furthermore, it aimed to clarify the impact of a newly established Fast Track Clinic (FTC) approach on hospitalisation rates in connection with PMR diagnosis.MethodsPatients diagnosed with PMR at South-West Jutland Hospital, Denmark, between 2013 and 2018 were included retrospectively. Only patients fulfilling the 2012 EULAR/ACR classification criteria were included in our cohort. An FTC for patients suspected of having PMR was established in the rheumatologic department of South-West Jutland Hospital in January 2018.ResultsOver 6 years (2013 to 2017), 254 patients were diagnosed with PMR, 56 of them while hospitalised. Hospitalised patients were more likely to have a higher initial CRP mean ± standard deviation (SD) 99.53 ± 59.36 vs 45.82 ± 36.96 mg/lt (p < 0.0001) and a shorter duration of symptoms (p = 0.0018). After implementing the FTC, a significant decrease in hospitalisation rates (from 20.4% to 3,5%) and inpatient days of care (mean ± SD 4.15 ± 3.1 vs 1 ± 0) were observed. No differences between the two groups were observed regarding clinical symptoms, laboratory values and initial prednisolone dose.ConclusionA substantial number of patients are hospitalised in connection with the PMR diagnosis. The FTC approach can decrease the hospitalisation rates significantly among these patients.Trial registrationRetrospectively registered.
Highlights
Polymyalgia rheumatica (PMR) is characterised by shoulder and hip girdle pain accompanied by systemic inflammation [1]
PMR patients can be treated in the primary sector, and no specific criteria for which PMR suspected patients should directly be referred to a rheumatologist exist in Denmark
Four hundred seventy-six patients were registered with the diagnosis of PMR during the study period
Summary
Polymyalgia rheumatica (PMR) is characterised by shoulder and hip girdle pain accompanied by systemic inflammation [1]. The incidence increases with age, and PMR is rarely seen before the age of 50 years. Populations of Scandinavian ancestry are at higher risk of developing PMR [2]. The vast majority of PMR patients are diagnosed and managed in general practice [3,4,5]. Diagnosing PMR can be challenging as many conditions can mimic the disease [6]. The variety of symptoms may lead to hospitalisation to rule out other serious diseases [7]. In a study from the United Kingdom [8], a majority of general practitioners (GPs) reported that they considered several other conditions (i.e., GCA, infection, malignancy) as the cause of symptoms in their differential diagnosis. Treatment cannot be used in a diagnostic approach as the patient’s immediate response to low dose (15-20 mg) prednisolone (2021) 5:37 daily is not always achieved within a few days/weeks after treatment initiation [9, 10]
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