Top

20-11-2018 | Polymyalgia rheumatica | Article

Comorbidities in polymyalgia rheumatica: a systematic review

Journal: Arthritis Research & Therapy

Authors: Richard Partington, Toby Helliwell, Sara Muller, Alyshah Abdul Sultan, Christian Mallen

Publisher: BioMed Central

Abstract

Background and aim

Comorbidities are known to exist in many rheumatological conditions. Polymyalgia rheumatica (PMR) is a common inflammatory rheumatological condition affecting older people which, prior to effective treatment, causes severe disability. Our understanding of associated comorbidities in PMR is based only on case reports or series and small cohort studies. The objective of this study is to review systematically the existing literature on the comorbidities associated with PMR.

Methods

MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched for original observational research from inception to November 2016. Papers containing the words ‘Polymyalgia Rheumatica’ OR ‘Giant Cell Arteritis’ OR the terms ‘PMR’ OR ‘GCA’ were included. Article titles were reviewed based on pre-defined criteria by two reviewers. Following selection for inclusion, studies were quality assessed using the Newcastle–Ottawa tool and data were extracted.

Results

A total of 17,329 papers were reviewed and 41 were incorporated in this review, including three published after the search took place. Wide variations were found in study design, comorbidities reported and populations studied. Positive associations were found between PMR diagnosis and stroke, cardiovascular disease, peripheral arterial disease, diverticular disease and hypothyroidism. Two studies reported a positive association between PMR and overall malignancy rate. Seven studies reported an association between PMR and specific types of cancer, such as leukaemia, lymphoma, myeloproliferative disease and specified solid tumours, although nine studies found either no or negative association between cancer and PMR.

Conclusion

Quantification of the prevalence of comorbidities in PMR is important to accurately plan service provision and enable identification of cases of PMR which may be more difficult to treat. This review highlights that research into comorbidities in PMR is, overall, methodologically inadequate and does not comprehensively cover all comorbidities. Future studies should consider a range of comorbidities in patients with a validated diagnosis of PMR in representative populations.

Michet CJ, Matteson EL. Polymyalgia rheumatica. Br Med J. 2008;336:765–9. https://doi.org/10.1016/S0140-6736(97)05001-0.CrossRef

Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008;372(9634):234–45. https://doi.org/10.1016/S0140-6736(08)61077-6.CrossRefPubMed

Chuang TY, Hunder GG, Ilstrup DM, Kurland LT. Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. Ann Intern Med. 1982;97(5):672–80.CrossRef

Salvarani C, Macchioni PL, Tartoni PL, et al. Polymyalgia rheumatica and giant cell arteritis: a 5-year epidemiologic and clinical study in Reggio Emilia, Italy. Clin Exp Rheumatol. 1987;5(3):205–15.PubMed

Dasgupta B, Borg FA, Hassan N, et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology. 2010;49(1):186–90. https://doi.org/10.1093/rheumatology/kep303a.CrossRefPubMed

Clarson L, Chandratre P, Hider S, et al. Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis. Eur J Prev Cardiol. 2013;22(3):335–43. https://doi.org/10.1177/2047487313514895.CrossRefPubMed

Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2012;71(9):1524–9. https://doi.org/10.1136/annrheumdis-2011-200726.CrossRefPubMed

Pamuk ÖN, Ünlü E, Çakir N. Role of insulin resistance in increased frequency of atherosclerosis detected by carotid ultrasonography in rheumatoid arthritis. J Rheumatol. 2006;33(12):2447–52.PubMed

Jonsson SW, Backman C, Johnson O, et al. Increased prevalence of atherosclerosis in patients with medium term rheumatoid arthritis. J Rheumatol. 2001;28(12):2597–602 pmid: 11764203.PubMed

10.

Kumeda Y, Inaba M, Goto H, et al. Increased thickness of the arterial intima-media detected by ultrasonography in patients with rheumatoid arthritis. Arthritis Rheum. 2002;46(6):1489–97. https://doi.org/10.1002/art.10269.CrossRefPubMed

11.

Dessein PH, Norton GR, Woodiwiss AJ, Joffe BI, Wolfe F. Influence of nonclassical cardiovascular-risk factors on the accuracy of predicting subclinical atherosclerosis in rheumatoid arthritis. J Rheumatol. 2007;34(5):943–51.PubMed

12.

Brown K. Rheumatoid lung disease. Proc Am Thorac Soc. 2007;4:443–8. https://doi.org/10.1513/pats.200703-045MS.CrossRefPubMedPubMedCentral

13.

Chen Y-J, Chang Y-T, Wang C-B, Wu C-Y. The risk of cancer in patients with rheumatoid arthritis: A nationwide cohort study in Taiwan. Arthritis Rheum. 2011;63(2):352–8. https://doi.org/10.1002/art.30134.CrossRefPubMed

14.

Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2015;74:1799–807. https://doi.org/10.1136/annrheumdis-2015-207492.CrossRefPubMed

15.

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. https://doi.org/10.1016/S0140-6736(12)60240-2.CrossRefPubMed

16.

Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med. 2002;347(4):261–71.CrossRef

17.

Weyand CM, Goronzy J. Giant-cell arteritis and polymyalgia rheumatica. Ann Intern Med. 2003;139:505–16.CrossRef

18.

Moher D, Liberati A, Tetzlaff J, Altman DG, Grp P. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement (reprinted from Annals of Internal Medicine). PLoS ONE. 2009;6(7):1-6. https://doi.org/10.1371/journal.pmed.1000097.CrossRef

19.

Byrt T, Bishop J, Carlin JB. Bias, prevalence and kappa. J Clin Epidemiol. 1993;46(5):423–9. https://doi.org/10.1016/0895-4356(93)90018-V.CrossRefPubMed

20.

Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012;64(4):943–54. https://doi.org/10.1002/art.34356.CrossRefPubMed

21.

Behn AR, Perera T, Myles AB. Polymyalgia rheumatica and corticosteroids: how much for how long? Ann Rheum Dis. 1983;42(4):374–8. https://doi.org/10.1136/ard.42.4.374.CrossRefPubMedPubMedCentral

22.

Gabriel SE, Sunku J, Salvarani C, O’Fallon WM, Hunder GG. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum. 1997;40(10):1873–8. https://doi.org/10.1002/art.1780401022.CrossRefPubMed

23.

Mazzantini M, Torre C, Miccoli M, et al. Adverse events during longterm low-dose glucocorticoid treatment of polymyalgia rheumatica: a retrospective study. J Rheumatol. 2012;39(3):552–7. https://doi.org/10.3899/jrheum.110851.CrossRefPubMed

24.

Proven A, Gabriel SE, Orces C, O’Fallon WM, Hunder GG. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum. 2003;49(5):703–8. https://doi.org/10.1002/art.11388.CrossRefPubMed

25.

Paskins Z, Whittle R, Sultan AA, et al. Risk of fracture among patients with polymyalgia rheumatica and giant cell arteritis: a population-based study. BMC Med. 2018;16(4):1–9. https://doi.org/10.1186/s12916-017-0987-1.CrossRef

26.

Shbeeb I, Challah D, Raheel S, Crowson CS, Matteson EL. Comparable rates of glucocorticoid associated adverse events in patients with polymyalgia rheumatica and comorbidities in the general population. Arthritis Care Res. 2018;70(4):643–7. https://doi.org/10.1002/acr.23320.CrossRef

27.

Albrecht K, Huscher D, Buttgereit F, et al. Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database. Rheumatol Int. 2018;38(4):569–77. https://doi.org/10.1007/s00296-017-3874-3.CrossRefPubMed

28.

Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed 1 Nov 2016.

29.

Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. Available from http://handbook.cochrane.org.

30.

Bengtsson BA, Malmvall BE. The epidemiology of giant cell arteritis including temporal arteritis and polymyalgia rheumatica. Incidences of different clinical presentations and eye complications. Arthritis Rheum. 1981;24(7):899–904.CrossRef

31.

Bowness P, Shotliff K, Middlemiss A, Myles AB. Prevalence of hypothyroidism in patients with polymyalgia rheumatica and giant cell arteritis. Br J Rheumatol. 1991;30(5):349–51.CrossRef

32.

Haga H, Eide G, Brun J, Johansen A, Langmark F. Cancer in association with polymyalgia rheumatica and temporal arteritis. J Rheumatol. 1993;20(8):1335–9.PubMed

33.

Juchet H, Labarthe M, Ollier S, Vilain C, Arlet P. Prevalence of hypothyroidism and hyperthyroidism in patients with giant cell arteritis or polymyalgia rheumatica: a controlled study in one hundred and four cases. Rev du Rhum English Ed. 1993;60(7–8):406–11.

34.

Schaufelberger C, Bengtsson BA, Andersson R. Epidemiology and mortality in 220 patients with polymyalgia rheumatica. Br J Rheumatol. 1995;34(3):261–4. https://doi.org/10.1093/rheumatology/34.3.261.CrossRefPubMed

35.

Gran JT, Myklebust G, Wilsgaard T, Jacobsen BK. Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls. Rheumatology. 2001;40(11):1238–42 http://www.ncbi.nlm.nih.gov/pubmed/11709607.CrossRef

36.

Uddhammar A, Eriksson A-L, Nyström L, et al. Increased mortality due to cardiovascular disease in patients with giant cell arteritis in northern Sweden. J Rheumatol. 2002;29(4):737–42.PubMed

37.

Myklebust G, Wilsgaard T, Jacobsen BK, Gran TJ. No increased frequency of malignant neoplasms in polymyalgia rheumatica and temporal arteritis. A prospective longitudinal study of 398 cases and matched population controls. J Rheumatol. 2002;29(10):2143–7.PubMed

38.

Doran MF, Crowson CS, O’Fallon WM, Hunder GG, Gabriel SE. Trends in the incidence of polymyalgia rheumatica over a 30 year period in Olmsted County, Minnesota, USA. J Rheumatol. 2002;29(8):1694–7.PubMed

39.

Myklebust G, Wilsgaard T, Jacobsen BK, Gran JT. Causes of death in polymyalgia rheumatica. A prospective longitudinal study of 315 cases and matched population controls. Scand J Rheumatol. 2003;32(1):38–41. https://doi.org/10.1080/03009740310000382.CrossRefPubMed

40.

Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE. Direct medical costs of polymyalgia rheumatica. Arthritis Rheum. 2005;53(4):578–84. https://doi.org/10.1002/art.21311.CrossRefPubMed

41.

Eaton WW, Rose NR, Kalaydjian A, Pedersen MG, Mortensen PB. Epidemiology of autoimmune diseases in Denmark. J Autoimmun. 2007;29(1):1–9.CrossRef

42.

Kremers HMH, Reinalda MMS, Crowson CCS, Davis JMJ, Hunder GGG, Gabriel SES. Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica. Arthritis Care Res. 2007;57(2):279–86. https://doi.org/10.1002/art.22548.CrossRef

43.

Warrington KJ, Jarpa EP, Crowson CS, et al. Increased risk of peripheral arterial disease in polymyalgia rheumatica: a population-based cohort study. Arthritis Res Ther. 2009;11(2):R50. https://doi.org/10.1186/ar2664.CrossRefPubMedPubMedCentral

44.

Eaton WW, Byrne M, Ewald H, et al. Association of schizophrenia and autoimmune diseases: linkage of Danish national registers. Am J Psychiatry. 2006;163(3):521–8. https://doi.org/10.1176/appi.ajp.163.3.521.CrossRefPubMed

45.

Ji J, Liu X, Sundquist K, Sundquist J, Hemminki K. Cancer risk in patients hospitalized with polymyalgia rheumatica and giant cell arteritis: a follow-up study in Sweden. Rheumatology. 2010;49(6):1158–63.CrossRef

46.

Kang J-H, Sheu J-J, Lin H-C. Polymyalgia rheumatica and the risk of stroke: a three-year follow-up study. Cerebrovasc Dis. 2011;32(5):497–503. https://doi.org/10.1159/000332031.CrossRefPubMed

47.

Hemminki K, Liu X, Ji J, Sundquist J, Sundquist K. Autoimmune disease and subsequent digestive tract cancer by histology. Ann Oncol. 2012;23(4):927–33. https://doi.org/10.1093/annonc/mdr333.CrossRefPubMed

48.

Zoller B, Li X, Sundquist J, Sundquist K. Risk of subsequent ischemic and hemorrhagic stroke in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden. BMC Neurol. 2012;12:41. https://doi.org/10.1186/1471-2377-12-41.CrossRefPubMedPubMedCentral

49.

Li X, Sundquist J, Sundquist K. Subsequent risks of Parkinson disease in patients with autoimmune and related disorders: a nationwide epidemiological study from Sweden. Neurodegener Dis. 2012;10(1–4):277–84. https://doi.org/10.1159/000333222.CrossRefPubMed

50.

Hemminki K, Liu X, Ji J, Sundquist J, Sundquist K. Effect of autoimmune diseases on mortality and survival in subsequent digestive tract cancers. Ann Oncol. 2012;23(8):2179–84. https://doi.org/10.1093/annonc/mdr590.CrossRefPubMed

51.

Hemminki K, Liu X, Ji J, Forsti A, Sundquist J, Sundquist K. Effect of autoimmune diseases on risk and survival in female cancers. Gynecol Oncol. 2012;127(1):180–5. https://doi.org/10.1016/j.ygyno.2012.07.100.CrossRefPubMed

52.

Zöller B, Li X, Sundquist J, Sundquist K. Risk of subsequent coronary heart disease in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden. PLoS One. 2012;7(3):1–8. https://doi.org/10.1371/journal.pone.0033442.CrossRef

53.

Hemminki K, Li X, Sundquist J, Sundquist K. Risk of asthma and autoimmune diseases and related conditions in patients hospitalized for obesity. Ann Med. 2012;44(3):289–95.CrossRef

54.

Hemminki K, Liu X, Forsti A, Ji J, Sundquist J, Sundquist K. Effect of autoimmune diseases on incidence and survival in subsequent multiple myeloma. J Hematol Oncol. 2012;5:59.CrossRef

55.

Fallah M, Liu X, Ji J, Forsti A, Sundquist K, Hemminki K. Hodgkin lymphoma after autoimmune diseases by age at diagnosis and histological subtype. Ann Oncol. 2014;25(7):1397–404. https://doi.org/10.1093/annonc/mdu144.CrossRefPubMed

56.

Fallah M, Liu X, Ji J, Forsti A, Sundquist K, Hemminki K. Autoimmune diseases associated with non-Hodgkin lymphoma: a nationwide cohort study. Ann Oncol. 2014;25:2025–30. https://doi.org/10.1093/annonc/mdu365.CrossRefPubMed

57.

Muller S, Hider SLS, Belcher J, Helliwell T, Mallen CD. Is cancer associated with polymyalgia rheumatica? A cohort study in the General Practice Research Database. Ann Rheum Dis. 2014;73:1769–73. https://doi.org/10.1136/annrheumdis-2013-203465.CrossRefPubMed

58.

Hancock AT, Mallen CD, Muller S, et al. Risk of vascular events in patients with polymyalgia rheumatica. Can Med Assoc J. 2014;186(13):495–501.CrossRef

59.

Pfeifer EC, Crowson CS, Major BT, Matteson EL. Polymyalgia Rheumatica and its Association with Cancer. Rheumatology (Sunnyvale). 2015;(Suppl 6):003. https://doi.org/10.4172/2161-1149.S6-003.Polymyalgia.

60.

Pujades-Rodriguez M, Duyx B, Thomas SL, Stogiannis D, Smeeth L, Hemingway H. Associations between polymyalgia rheumatica and giant cell arteritis and 12 cardiovascular diseases. Heart. 2016;102(5):383–9.CrossRef

61.

Bellan M, Boggio E, Sola D, et al. Association between rheumatic diseases and cancer: results from a clinical practice cohort study. Intern Emerg Med. 2017;12(5):621-7. https://doi.org/10.1007/s11739-017-1626-8.CrossRef

62.

Askling J, Klareskog L, Hjalgrim H, Baecklund E, Bjorkholm M, Ekbom A. Do steroids increase lymphoma risk? A case-control study of lymphoma risk in polymyalgia rheumatica/giant cell arteritis. Ann Rheum Dis. 2005;64(12):1765–8.CrossRef

63.

Anderson LA, Pfeiffer RM, Landgren O, Gadalla S, Berndt SI, Engels EA. Risks of myeloid malignancies in patients with autoimmune conditions. Br J Cancer. 2009;100(5):822–8.CrossRef

64.

Anderson LA, Gadalla S, Morton LM, et al. Population-based study of autoimmune conditions and the risk of specific lymphoid malignancies. Int J Cancer. 2009;125(2):398–405.CrossRef

65.

Lanoy E, Engels EA. Skin cancers associated with autoimmune conditions among elderly adults. Br J Cancer. 2010;103(1):112–4.CrossRef

66.

Kristinsson SY, Landgren O, Samuelsson J, Bjorkholm M, Goldin LR. Autoimmunity and the risk of myeloproliferative neoplasms. Haematologica. 2010;95(7):1216–20. https://doi.org/10.3324/haematol.2009.020412.CrossRefPubMedPubMedCentral

67.

Anderson LA, Engels EA. Autoimmune conditions and hairy cell leukemia: an exploratory case-control study. J Hematol Oncol. 2010;3:35.CrossRef

68.

Lindqvist EK, Goldin LR, Landgren O, et al. Personal and family history of immune-related conditions increase the risk of plasma cell disorders: a population-based study. Blood. 2011;118(24):6284–91.CrossRef

69.

Chen SJ, Chao YL, Chen CY, et al. Prevalence of autoimmune diseases in in-patients with schizophrenia: nationwide population-based study. Br J Psychiatry. 2012;200:374–80. https://doi.org/10.1192/bjp.bp.111.092098.CrossRefPubMed

70.

Scrivo R, Gerardi MC, Rutigliano I, et al. Polymyalgia rheumatica and diverticular disease: just two distinct age-related disorders or more? Results from a case-control study. Clin Rheumatol. 2018;37(9):2573-7. https://doi.org/10.1007/s10067-018-4137-8.CrossRef

71.

Yates M, Graham K, Watts R, MacGregor A. The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population. BMC Musculoskelet Disord. 2016;17:285.CrossRef

72.

Barraclough K, Liddell WG, du Toit J, et al. Polymyalgia rheumatica in primary care: a cohort study of the diagnostic criteria and outcome. Fam Pract. 2008;25(5):328–33.CrossRef

73.

Hellgren K, Baecklund E, Backlin C, Sundstrom C, Smedby KE, Askling J. Rheumatoid Arthritis and risk of malignant lymphoma: is the risk still increased? Arthritis Rheumatol. 2017;69(4):700–8. https://doi.org/10.1002/art.40017.CrossRefPubMed

74.

Floris A, Piga M, Cauli A, Salvarani C, Mathieu A. Polymyalgia rheumatica: zn autoinflammatory disorder? RMD Open. 2018;4(1):2–6. https://doi.org/10.1136/rmdopen-2018-000694.CrossRef

75.

Haut ER, Pronovost PJ. Surveillance bias in outcomes reporting. JAMA. 2011;305(23):2462–3. https://doi.org/10.1001/jama.2011.822.CrossRefPubMed

76.

Piccirillo JF, Vlahiotis A, Barrett LB, Flood KL, Spitznagel EL, Steyerberg EW. The changing prevalence of comorbidity across the age spectrum. Crit Rev Oncol Hematol. 2008;67(2):124–32. https://doi.org/10.1016/j.critrevonc.2008.01.013.CrossRefPubMedPubMedCentral