Room for Improvement in Polymyalgia Rheumatica Referral, Management

For better clinical practice and clinical trial recruitment, strategies are needed to guide the management and referral of patients with polymyalgia rheumatica, researchers advised in a study published in the journal Rheumatology.

“This large international survey indicates that a large proportion of people with polymyalgia rheumatica are not referred for diagnosis, and that the proportion of treatment-naïve patients declined with increasing time from referral to assessment,” wrote corresponding author Kresten Krarup Keller, MD, PhD, of the Aarhus University Hospital Department of Rheumatology in Denmark, and coauthors.

To gather data for the study, a working group of rheumatologists and general practitioners from six countries created and distributed a questionnaire about current management practices for patients with polymyalgia rheumatica, referral practices, and barriers to research.

Responses from 394 general practitioners who completed the questionnaire indicated they referred a median 25% of patients with suspected polymyalgia rheumatica to rheumatologists for diagnosis. Half of those patients were referred back to the general practitioner for management, according to the study.

Among 937 rheumatologists who responded to the survey, 39% saw patients with suspected polymyalgia rheumatica for evaluation more than 2 weeks after their referral. By that time, a median half of the patients had already started prednisolone.

Some 30% of general practitioners started patients on daily prednisolone at a dosage above 25 mg, the study found, compared with 12% of rheumatologists. Diagnostic imaging was rare.

“More than half (56%) of rheumatologists experienced difficulties recruiting people with polymyalgia rheumatica to clinical trials,” researchers reported.

Reference:
Donskov AO, Mackie SL, Hauge EM, et al. An international survey of current management practices for polymyalgia rheumatica by general practitioners and rheumatologists. Rheumatology (Oxford). Published online January 13, 2023. doi:10.1093/rheumatology/keac713