Adverse Events During Longterm Low-dose Glucocorticoid Treatment of Polymyalgia Rheumatica: A Retrospective Study
Mazzantini M, Torre C, Miccoli M, et al
J Rheumatol. 2012;39:552-557
Glucocorticoids are the mainstay of therapy for polymyalgia rheumatica (PMR). Although doses used for this disease are typically low (< 20 mg/day), therapy can often be used for several years. Furthermore, patients with PMR are typically older and have other comorbidities, placing them at higher risk for steroid-associated adverse effects. In this retrospective study, Mazzantini and colleagues attempted to quantify this risk by evaluating adverse events associated with long-term glucocorticoid use in patients with PMR.
The investigators identified 222 patients with PMR from 1 center, followed for a mean of 60 months, with an overall mean duration of glucocorticoid use of 46 months. The mean age at diagnosis of PMR was 71 years, and approximately 70% of patients were women. The cumulative dose of glucocorticoid (typically methylprednisolone) was 4.4 g. The investigators found that 43% of these patients had at least 1 adverse event that could be attributed at least in part to glucocorticoid use. These events, and approximate percentages of patients affected, included:
Development of osteoporosis (25%);
New fragility fracture (14%);
Arterial hypertension (12%);
Diabetes mellitus (5%); and
Cardiovascular disease events (6%).
Overall, these adverse events were associated with a higher cumulative dose and duration of glucocorticoid use, and a higher frequency of adverse events was seen in patients treated for longer than 2 years. Of note, approximately 80% of the patients with fractures had been evaluated for osteoporosis, and more than 90% were on bisphosphonate therapy. The investigators concluded that long-term, low-dose glucocorticoid treatment of PMR is associated with significant adverse events.