Supplement Article |
PP5. POLYMYALGIA RHEUMATICA (PMR) CAN RECUR YEARS AFTER DISCONTINUATION OF STEROID THERAPY
Brigham and Women's Hospital, Boston, MA, USA
Background: Although relapses of PMR are well recognized, overt recurrences of the disease have been but glancingly acknowledged. (Relapse is herewith defined as increased disease activity, including worsened symptoms and rises in the acute phase reactants, occurring in the face of ongoing treatment; recurrence is defined as increased disease activity after cessation of treatment.)
Methods: 12 patients with recurrences of PMR years after discontinuation of steroid therapy were culled from my clinical practice of 30 years. In order to insure separation from mere relapsing disease, I have included only patients off treatment for at least 2 years. All patients had PMR per the Healey criteria (Semin Arthritis Rheum 1984;13;322–8) at the time of initial diagnosis and of subsequent recurrence(s). 3 patients with ESRs <40 who fulfilled these criteria were included. No patient was positive for rheumatoid factor, and none developed erosive disease during the periods of follow-up.
Results: 12 patient are described, 8 female and 4 male, ranging in age at the time of initial diagnosis from 53 to 78 years (mean 64.1 years). The period of follow-up ranged from 7.3 to 25.1 years (mean 14.3 years). The duration of initial steroid therapy ranged from to 1 to 11.1 years (mean 3.4 years). At the time steroids were discontinued, patients were asymptomatic, and sedimentation rates had normalized. The duration between discontinuation of steroid therapy and its resumption for recurring disease was 2.0 to 14.7 years (mean 6.1 years). 3 patients had more than one recurrence, as defined above. 5 recurrences were accompanied by peripheral arthritis. 1 case of giant cell arteritis occurred.
Conclusions: PMR may recur after long periods off treatment. Why the disease is polyphasic in some patients and monophasic in others is unclear.