title: Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica: a systematic literature review informing the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for the management of polymyalgia rheumatica.
abstract: To summarise evidence on therapeutic interventions and prognostic factors in polymyalgia rheumatica (PMR). A systematic literature review was conducted using Ovid Medline, Embase, PubMed, CINAHL, Web of Science and the Cochrane Library (1970 through April 2014). Quality of evidence (QoE) of identified studies was appraised by Grading of Recommendations Assessment, Development and Evaluation (GRADE) (interventions) and the Quality In Prognosis Studies (QUIPS) methodologies (prognostic factors). Out of 10 931 titles identified, 52 articles were finally selected. A single study indicated that an initial prednisone dose of 20 mg/day is associated with a lower short-term relapse rate than 10 mg/day but at the cost of a higher rate of adverse events. Another study suggested a comparable efficacy of intramuscular methylprednisolone and oral glucocorticoids (GCs) with lower cumulative GC doses and less weight gain in the former group. Moderate to high QoE (1-2 studies) indicated a benefit of methotrexate in remission rates and cumulative GC doses in early PMR. Anti-tumour necrosis factor α agents are ineffective for PMR treatment. Among prognostic factors, female sex, high erythrocyte sedimentation rate (ESR) and peripheral arthritis were associated in some studies with a higher relapse risk. Women and patients with high ESR also appeared to have a longer duration of treatment. Several studies of varying quality, however, failed to prove these associations. In PMR, evidence for initial GC doses and subsequent tapering regimens is limited. Intramuscular methylprednisolone and methotrexate may be effective GC sparing agents. Female sex, high ESR and peripheral arthritis at disease outset are potential risk factors for a worse prognosis.
authors.affiliation: Department of Rheumatology, Medical University Graz, Graz, Austria Department of Rheumatology, Southend University Hospital, Southend, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Dejaco
authors.affiliation: Department of Rheumatology, Southend University Hospital, Southend, UK.
authors.forename: Yogesh P
authors.initials: YP
authors.lastname: Singh
authors.affiliation: Epidemiology & Population Health Faculty, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Pablo
authors.initials: P
authors.lastname: Perel
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hutchings
authors.affiliation: Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, University of Genova, Genova, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Camellino
authors.affiliation: NIHR-Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mackie
authors.affiliation: Division of Rheumatology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.affiliation: Department of Rheumatology, Southend University Hospital, Southend, UK.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Dasgupta
mesh_terms: D000284:Administration, Oral; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000379:methods; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007273:Injections, Intramuscular; D011111:Polymyalgia Rheumatica / Q000175:diagnosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids
keywords: Methotrexate; Polymyalgia Rheumatica; Treatment