title: Study of professional practices among rheumatologists in Burgundy: initial corticotherapy in polymyalgia rheumatica.
abstract: To study the initial dose of corticoids prescribed by rheumatologists in the Côte d'Or, a French department of Burgundy, in the treatment of polymyalgia rheumatica (PMR), the clinical and biological data of patients who consulted rheumatologists of the Côte d'Or between March 2006 and December 2008 for PMR were collected. The statistical analyses concerned the initially prescribed dose of prednisone: the median, mean, and standard deviation were calculated cumulatively and then for individual rheumatologists; the Mann-Whitney test was used to compare the mean initial doses prescribed with regard to (a) the main practice of the practitioner (private-practice or hospital rheumatologist), (b) the presence of clinical signs of severity, (c) severity of the inflammatory syndrome, and (d) the presence of clinical relapse with the decrease in corticoids. Ninety-nine patients were included (age = 72 ± 8.6 years, 59% women). The mean dose of prednisone prescribed was 27.4 ± 12.4 mg/day. Considerable inter- and intra-individual variabilities in the doses prescribed were noted. There was no significant difference concerning the dose prescribed according to the clinical severity or the type of practice. However, the dose was significantly higher (34.3 ± 14.7 vs. 25.5 ± 11.1 mg/day) in patients with a high sedimentation rate. Clinical relapse was not statistically linked to the initial dose of corticoids. This evaluation of professional practices among French rheumatologists shows that the initial dose of prednisone prescribed in PMR varies considerably and is higher than the dose currently recommended in the literature (15 mg/day).
authors.affiliation: Service de Rhumatologie, Dijon University Hospital, Dijon, 21078, France. paul.ornetti@chu-dijon.fr
authors.forename: Paul
authors.initials: P
authors.lastname: Ornetti
authors.forename: Caroline
authors.initials: C
authors.lastname: Guillibert-Karras
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Garrot
authors.forename: Florence
authors.initials: F
authors.lastname: Gros
authors.forename: Nathalie
authors.initials: N
authors.lastname: Gérard
authors.forename: Laurence
authors.initials: L
authors.lastname: Julien
authors.forename: Françoise
authors.initials: F
authors.lastname: Pascaud
authors.forename: Thierry
authors.initials: T
authors.lastname: Peere
authors.forename: Monique
authors.initials: M
authors.lastname: Petit-Perrin
authors.forename: Christine
authors.initials: C
authors.lastname: Piroth
authors.forename: Christian
authors.initials: C
authors.lastname: Tavernier
authors.forename: Jean-Francis
authors.initials: JF
authors.lastname: Maillefert
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D005260:Female; D005602:France; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000175:diagnosis* / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011241:Prednisone / Q000008:administration & dosage; D012008:Recurrence; D015203:Reproducibility of Results; D012219:Rheumatology / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D011241:Prednisone