LAUSR

Background Glucocorticoids (GCs) are effective for polymyalgia rheumatica (PMR); however, some patients relapse during GC tapering and develop adverse events of GCs. Objectives To identify risk factors for recurrence in patients with polymyalgia Rheumatica(PMR). Methods Cox proportional hazards regression analyses was performed 78 patients with PMR who had been treated by 2015 EULAR/ACR recommendations between January2015 and December 2017 in our centre. The following data at baseline were collected retrospectively: age, sex, time of diagnosis, location of arthralgia/myalgia, maximum dose of prednisolone, US findings of shoulder, laboratory data before the initial treatment. Results Seventy-eight patients had been diagnosed with the 2012 EULAR/ACR provisional classification criteria for PMR, and had been treated first with GCs. They were at the age of 71.7±9.5, including 34 males and 44 females. Duration of symptoms before therapy was 2.0±2.0 months and the PMR duration was 21.2±15.5 months. Twenty-seven patients had arthralgia/myalgia other than shoulders and hips. The maximum dose of prednisolone was 15.9±4.4 mg/day. US findings of shoulder were positive in 65 patients. Relapses occurred in 37 patients (47%), when the dose of prednisolone was reduced to 5.6±5.5 mg/day at 8.9±6.4 months. MTX (8.6±3.1 mg/wk) was added in 29 patients or the dose of prednisolone was increased in 8 patients, similarly to the 2015 EULAR/ACR recommendations for the management of PMR. Additional MTX was ineffective in 16 patients, followed by adding tocilizumab in 8 patients. Forty patients discontinued GCs at 17.6±10.6 months. On univariate analysis, 4 variables were identified as significant risk factors affecting PMR recurrence: increased platelets (p=0.00192), low IgA (p=0.00149), arthralgia/myalgia limited to shoulders and hips (p=0.02), and the maximum dose of prednisolone used (p=0.0062). These 4 variables were introduced into the multivariate analysis, and the following 3 variables were retained as independent significant risk factors: the maximum dose of prednisolone(p<0.005), limitation of arthralgia/myalgia to shoulders and hips(p<0.05) and low IgA (p<0.005). Conclusions These results indicate that the maximum dose of prednisolone, the absence of peripheral joint pains and low IgA may be associated with the recurrence in PMR patients Disclosure of Interest None declared