Withdrawal of Glucocorticoid Therapy is Difficult in Women with Polymyalgia Rheumatica: An Observational Study

Dai Aoki; Nobuyuki Kajiwara; Keiko Irishio; Yasuhiro Kato; Shinya Suezaki; Misaki Kageyama; Masahiro Misago; Daisuke Tamai; Shinichiro Nakao; Takato Ueoka; Mototoshi Ito; Shinichiro Murakami

doi:10.2147/IJGM.S322111

Withdrawal of Glucocorticoid Therapy is Difficult in Women with Polymyalgia Rheumatica: An Observational Study

Int J Gen Med. 2021 Oct 5:14:6417-6422. doi: 10.2147/IJGM.S322111. eCollection 2021.

Authors

Dai Aoki^{1

2}, Nobuyuki Kajiwara^{3

4}, Keiko Irishio⁵, Yasuhiro Kato⁶, Shinya Suezaki¹, Misaki Kageyama¹, Masahiro Misago¹, Daisuke Tamai⁷, Shinichiro Nakao¹, Takato Ueoka¹, Mototoshi Ito¹, Shinichiro Murakami^{1

4}

Affiliations

¹ Department of Emergency and General Medicine, Ikeda City Hospital, Ikeda, Osaka, Japan.
² Fukuchiyama City Hospital Ooe-Branch, Fukuchiyama, Kyoto, Japan.
³ Department of Nephrology, Ikeda City Hospital, Ikeda, Osaka, Japan.
⁴ Toyono Town National Health Insurance Clinic, Toyono, Osaka, Japan.
⁵ Department of Clinical Research, Ikeda City Hospital, Ikeda, Osaka, Japan.
⁶ Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
⁷ Tamai Medical Clinic, Hannan, Osaka, Japan.

Abstract

Objective: A total of 105 patients (64 women) who were started on glucocorticoid (GC) treatment for polymyalgia rheumatica (PMR) and/or remitting seronegative symmetrical synovitis with pitting edema (RS₃PE) syndrome at Ikeda City Hospital from July 2004 to December 2019 were reviewed (PMR: 81, overlap: 20, pure RS₃PE syndrome: 4). Then, 32 cases that had stopped GC and 17 cases that had continued GC for 7.5 years or longer were evaluated (women:men, stopped GC 12:20, continued GC 13:4, respectively) (PMR:overlap:pure RS₃PE syndrome, stopped GC 26:6:0, continued GC 14:2:1, respectively).

Methods: The GC continuation rate in all patients was examined using the Kaplan-Meier method. The following were compared between the two groups: age at starting GC; sex; erythrocyte sedimentation rate, C-reactive protein, hemoglobin, ferritin, aspartate aminotransferase, and alanine aminotransferase before starting GC; days from the onset of symptoms to GC initiation; GC maximum dose; GC dose half a year after its start; presence of relapse; and existence of concomitant malignant disease.

Results: The GC continuation rate 7.5 years after GC initiation was 52.5%, higher in women (69.2%), than in men (27.1%). The rates then remained unchanged for 15 years. Hemoglobin was high, and relapse was uncommon in the group that stopped GC. There were no differences in other items.

Conclusion: It is difficult to stop GC therapy for PMR in women in Japan, especially in cases with severe anemia.

Keywords: discontinuation of therapy; glucocorticoid; polymyalgia rheumatica; remitting seronegative symmetrical synovitis with pitting edema syndrome; sex difference.