An international survey of current management practices for polymyalgia rheumatica by general practitioners and rheumatologists
Donskov, Agnete Overgaard Mackie, Sarah Louise Hauge, Ellen Margrethe Toro-Gutiérrez, Carlos Enrique Hansen, Ib Tønder Hemmig, Andrea Katharina Van der Maas, Aatke Gheita, Tamer Nielsen, Berit Dalsgaard Douglas, Karen M J
Donskov, Agnete Overgaard
Mackie, Sarah Louise
Hauge, Ellen Margrethe
Toro-Gutiérrez, Carlos Enrique
Hansen, Ib Tønder
Hemmig, Andrea Katharina
Van der Maas, Aatke
Gheita, Tamer
Nielsen, Berit Dalsgaard
Douglas, Karen M J
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Affiliation
Aarhus University Hospital; University of Leeds; Leeds Teaching Hospitals NHS Trust; Sandwell and West Birmingham NHS Trust; et al.
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Publication date
2023-08-01
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Abstract
Objectives: To explore current management practices for PMR by general practitioners (GPs) and rheumatologists including implications for clinical trial recruitment. Methods: An English language questionnaire was constructed by a working group of rheumatologists and GPs from six countries. The questionnaire focused on: 1: Respondent characteristics; 2: Referral practices; 3: Treatment with glucocorticoids; 4: Diagnostics; 5: Comorbidities; and 6: Barriers to research. The questionnaire was distributed to rheumatologists and GPs worldwide via members of the International PMR/Giant Cell Arteritis Study Group. Results: In total, 394 GPs and 937 rheumatologists responded to the survey. GPs referred a median of 25% of their suspected PMR patients for diagnosis and 50% of these were returned to their GP for management. In general, 39% of rheumatologists evaluated patients with suspected PMR >2 weeks after referral, and a median of 50% of patients had started prednisolone before rheumatologist evaluation. Direct comparison of initial treatment showed that the percentage prescribing >25 mg prednisolone daily for patients was 30% for GPs and 12% for rheumatologists. Diagnostic imaging was rarely used. More than half (56%) of rheumatologists experienced difficulties recruiting people with PMR to clinical trials. Conclusion: This large international survey indicates that a large proportion of people with PMR are not referred for diagnosis, and that the proportion of treatment-naive patients declined with increasing time from referral to assessment. Strategies are needed to change referral and management of people with PMR, to improve clinical practice and facilitate recruitment to clinical trials.
Citation
Donskov AO, Mackie SL, Hauge EM, Toro-Gutiérrez CE, Hansen IT, Hemmig AK, Van der Maas A, Gheita T, Nielsen BD, Douglas KMJ, Conway R, Rezus E, Dasgupta B, Monti S, Matteson EL, Sattui SE, Matza M, Ocampo V, Gromova M, Grainger R, Bran A, Appenzeller S, Goecke A, Colman N, Keen HI, Kuwana M, Gupta L, Salim B, Harifi G, Erraoui M, Ziade N, Al-Ani NA, Ajibade A, Knitza J, Frølund L, Yates M, Pimentel-Quiroz VR, Lyrio AM, Sandovici M, Van der Geest KSM, Helliwell T, Brouwer E, Dejaco C, Keller KK. An international survey of current management practices for polymyalgia rheumatica by general practitioners and rheumatologists. Rheumatology (Oxford). 2023 Aug 1;62(8):2797-2805. doi: 10.1093/rheumatology/keac713
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Article