Document Detail


Long-term follow-up of polymyalgia rheumatica patients treated with methotrexate and steroids.
MedLine Citation:
PMID:  18578959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: A series of patients with polymyalgia rheumatica (PMR) who received the steroid-sparing combination therapy, prednisone and methotrexate (MTX), underwent a long-term follow-up study at five years to investigate possible reductions of steroid-related side effects. Additional end-points were the number of patients still in need of steroid treatment, the cumulative steroid dose, and the number of flare-ups of PMR. PATIENTS AND METHODS: Fifty-seven PMR patients who were enrolled in a double-blind placebo-controlled randomised trial on the efficacy of MTX added to standard steroid treatment were reviewed after 5 years. Information was collected on the patients' previous health conditions or causes of death through a standardized questionnaire by direct visit, chart review, or interviews with relatives. RESULTS: After 6 years from initiation of therapy, MTX-treated patients had lower ESR (17.1+/-9.7 mm/h vs. 26.8+/-22.9 mm/h, p=0.08) and CRP (2.7+/-2.3 mg/L vs. 10.2+/-16.4 mg/L, p=0.04). 31% MTX-treated patients were still on steroids in comparison with 39.3% controls. The mean cumulative dosage of prednisone in MTX-treated patients was 2.6+/-3.8 g in comparison with 3.2+/-4.1 g for controls (p=0.6). PMR flare-ups were seen in 30.8% of MTX-treated patients and in 44.4% of controls (p=0.39). During the follow-up, 58 and 55 side effects were observed in MTX-treated patients and in controls, respectively. CONCLUSIONS: MTX-treated patients showed slightly less residual inflammation than controls, with the same incidence of steroid-related side effects. PMR is not a benign condition, as often reported, since one third of patients need steroid treatment for more than 6 years.
Authors:
M A Cimmino; C Salvarani; P Macchioni; R Gerli; E Bartoloni Bocci; C Montecucco; R Caporali;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical and experimental rheumatology     Volume:  26     ISSN:  0392-856X     ISO Abbreviation:  Clin. Exp. Rheumatol.     Publication Date:    2008 May-Jun
Date Detail:
Created Date:  2008-06-26     Completed Date:  2008-12-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8308521     Medline TA:  Clin Exp Rheumatol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  395-400     Citation Subset:  IM    
Affiliation:
Clinica Reumatologica, Dipartimento di Medicina Interna, Università di Genova, Italy. cimmino@unige.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Antirheumatic Agents / adverse effects,  therapeutic use*
Arthralgia / drug therapy
Dose-Response Relationship, Drug
Drug Therapy, Combination
Female
Follow-Up Studies
Glucocorticoids / adverse effects,  therapeutic use*
Humans
Longitudinal Studies
Male
Methotrexate / adverse effects,  therapeutic use*
Polymyalgia Rheumatica / drug therapy*
Prednisone / adverse effects,  therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antirheumatic Agents; 0/Glucocorticoids; 53-03-2/Prednisone; 59-05-2/Methotrexate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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