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Research into PMR

There are several ‘themes’ of research around PMR being published at the moment. There is lots of interest in defining what PMR actually is, and it was suggested at the 2013 British Society for Rheumatology (BSR) conference that it might be a group of conditions that all present in a similar way. There is also lots of interest in the diagnosis of both PMR and GCA and some very early evidence is emerging around potential new treatments and management strategies.

Diagnosis

Ultrasound scanning is emerging as a popular new tool to help the medical profession with diagnosis. In PMR, there is interest in looking at the shoulders to find signs of inflammation. Other areas of interest in the diagnosis of PMR at the moment are the use of a blood test for levels of plasma fibrinogen, which could be an alternative to commonly used ESR or CRP tests (McCarthy et al. 2013).

Treatment and outcomes

There are also a few studies looking at other types of imaging in PMR. These studies are not necessarily trying to find new ways to diagnose the condition, but are doing scans of people with PMR to try to better understand it. Some studies presented at the BSR conference in April suggest that, like GCA, PMR is potentially a form of vasculitis. This finding may fit with a recent systematic review of the published literature, which suggests a higher risk of vascular events such as heart attacks and strokes in people with PMR (Hancock et al 2013). This begs the question of whether people with PMR (and GCA) should be screened for vascular problems. This has been discussed in a recent article by Dr Sarah Mackie, a rheumatologist in Leeds who explains how screening is only helpful if it changes the treatment patients received (Mackie et al 2012). In terms of GCA, another study has shown that the risk of developing GCA is lower in people taking statins, but these drugs did not change the course or severity of the condition in those people who did develop it (Schmidt et al. 2013).

Another recently published study from a group of Italian researchers has looked at a range of other outcomes in PMR, mainly related to steroid treatments (Mazzantini et al. 2012). They showed that dose and duration of treatment was associated with osteoporosis and fractures. A UK study, which was presented at the BSR in 2012, also linked PMR to fatigue (Green et al. 2012).

At Keele University in Staffordshire, Professor Christian Mallen is leading a programme of work into PMR in primary care, where most patients are treated for the whole of the course of their disease. At the moment, Keele is running a questionnaire to study in people diagnosed with PMR very recently, with GPs referring patients into the study on the day that they are diagnosed (Muller et al 2012).This group of researchers is also conducting a study of people who have been diagnosed with PMR in the last 4 years to see how they are what treatments they have had and how their PMR has affected them.  . They will soon begin in-depth interviews with GPs about how they diagnose and treat the condition too. In another primary care study, Dr Helen Twohig at the University of Sheffield is designing a new questionnaire to assess how PMR affects patients from their point of view.

Dr Sarah Mackie at the University of Leeds is carrying out several interlinked research studies into PMR, GCA and the various side-effects of steroids. She is very keen to engage with patients, relatives, carers and the public at every stage of the research process, from initial identification of research priorities to final dissemination of research findings. For information on her current research please visit her webpage. Please note she cannot provide individual medical advice to patients, unless they are already under her direct care as a doctor.

Finally, the PMR OMERACT group are in the process of developing outcome measures to be used for future clinical trials in PMR. The group’s initial findings will be presented at the OMERACT conference in May this year

References

McCarthy et al. Plasma fibrinogen is an accurate marker of disease activity in patients with polymyalgia rheumatica. Rheumatology (Oxford). 2013;52(3):465-71.

Hancock et al. Association between polymyalgia rheumatica and vascular disease: a systematic review. Arthritis Care Res (Hoboken). 2012;64(9):1301-5.

Mackie et al. Should I send my patient with previous giant cell arteritis for imaging of the thoracic aorta? A systematic literature review and meta-analysis. Ann Rheum Dis. 2012 Dec 22. [Epub ahead of print]

Mazzantini et al . Adverse events during longterm low-dose glucocorticoid treatment of polymyalgia rheumatica: a retrospective study. J Rheumatol. 2012;39(3):552-7.

Green et al. Fatigue as a precursor to polymyalgia rheumatica: a retrospective cohort study [abstract]. Rheumatology (Oxford). 2012;51(Suppl 3).

Macchioni et al. Tocilizumab for polymyalgia rheumatica: Report of two cases and review of the literature. Semin Arthritis Rheum. 2013 Feb 20. pii: S0049-0172(13)00009-7.

Muller et al. The epidemiology of polymyalgia rheumatica in primary care: a research protocol. BMC Musculoskelet Disord. 2012;13:102.

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