Polymyalgia rheumatica: A case series from Colombia and analysis of Latin America

Carlos Enrique Toro-Gutiérrez; Carlos A Cañas; Rubén D Mantilla; Santiago Beltrán; Vivian Pastrana-Gonzalez; Milly J Vecino; Mónica Rodriguez-Jimenez; Manuel Rojas

doi:10.1016/j.jtauto.2021.100115

Polymyalgia rheumatica: A case series from Colombia and analysis of Latin America

J Transl Autoimmun. 2021 Aug 21:4:100115. doi: 10.1016/j.jtauto.2021.100115. eCollection 2021.

Authors

Carlos Enrique Toro-Gutiérrez¹, Carlos A Cañas², Rubén D Mantilla³, Santiago Beltrán⁴, Vivian Pastrana-Gonzalez¹, Milly J Vecino², Mónica Rodriguez-Jimenez⁴, Manuel Rojas⁴

Affiliations

¹ Centro de Referencia en Osteoporosis, Reumatología & Dermatología, Cali, Colombia.
² Rheumatology Unit, Fundación Valle Del Lili, Cali, Colombia.
³ Dermatology and Rheumatology Foundation (FUNINDERMA), Bogota, Colombia.
⁴ Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia.

Abstract

Objective: Polymyalgia rheumatica (PMR) is the most common inflammatory disease in patients over 50 years. Information about the disease in Latin America (LATAM) is scarce. We aimed to evaluate a group of Colombian patients with PMR and to conduct a systematic review of PMR in LATAM.

Methods: A multicentric retrospective study was performed. Medical records of 256 PMR patients were evaluated. Patients were divided into two groups, those fulfilling the 2012 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for PMR and those who did not (i.e., clinical diagnosis). A systematic literature review and meta regression was performed comparing Colombian vs LATAM patients.

Results: From 256 patients, 145 (56.6%) fulfilled the 2012 EULAR/ACR criteria, and 111 (43.3%) were classified by clinical diagnosis. Inflammatory bilateral shoulder pain, pelvic girdle aching, morning stiffness >45 min, elevated erythrocyte sedimentation rate (ESR), and C-reactive protein (CPR), and Methotrexate (MTX) prescription were more common in the 2012 EULAR/ACR group. None of the included patients presented overt polyautoimmunity (PolyA), whereas up to 24% exhibited latent PolyA. In addition, these patients showed high frequency of malignancy (7.59%). In the meta regression analysis, Colombian patients exhibited lower ESR levels, and were less likely to develop giant cell arteritis (GCA) as compared to the rest of LATAM data.

Conclusion: Patients with PMR in LATAM exhibit similar phenotypes from other cohorts worldwide. Malignancy, GCA and latent PolyA should be considered in the routine clinical follow-up of patients with PMR.

Keywords: ACPA, Cyclic citrullinated peptide antibody.; ANAs, Antinuclear antibodies.; CART, Classification and regression trees.; CI, Confidence interval.; CRP, C-reactive protein.; DMARDs, Disease-modifying antirheumatic drugs.; ESR, Erythrocyte sedimentation rate.; EULAR/ACR, European League Against Rheumatism/American College of Rheumatology.; GCA, Giant cell arteritis; GCs, Glucocorticoids.; Giant cell arteritis; IQR, Interquartile range.; LATAM, Latin America.; Latin America; MTX, Methotrexate.; Neoplasms; OR, Odds ratio.; PMR, Polymyalgia rheumatica.; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐analyses.; PolyA, Polyautoimmunity.; Polyautoimmunity; Polymyalgia rheumatica; RF, Rheumatoid factor.; SD, Standard deviation.; Systematic review; ts-DMARDs, Targeted-synthetic disease-modifying antirheumatic drugs..