VIDEO: Complications associated with polymyalgia rheumatica

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One thing, this is probably one of the reasons that has led to not paying as much attention to it, sadly, is that we know that, I think, across most studies, that PMR is not associated to an increased risk of mortality. And that is one of the main concerns with probably most of our other conditions, of course. However, we know that PMR is a really associated still with morbidity, both with either the disease or the treatments associated to it, and most importantly, really impacts the quality of life of patients. We have published data on it, and usually when I think of like the complications that can arise, patients who live with PMR, they both start with GC, but one is GCA and the other one is glucocorticoid. So we know that patients with PMR, I'm not talking about patients with GC and PMR, but patients who are initially diagnosed with PMR, between 10 and 20% of patients can go and develop giant arteritis, right?

So GCA associated with, of course, the risk of vision loss, the risk of other vascular complications, also demands higher doses of glucocorticoid, so there are a whole other list of things that can come with it, also is associated to an increase risk of cardiovascular disease. And although there has been some data potentially showing that as well in PMR, so GCA is one of the main concerns, and this is something that always needs to be on the back of our heads, both as treating providers, but also the patients need to be educated on this because it's very important for patients need to be aware, not to be scared, but need to be aware that symptoms that could be raising the concern or could be as early signs of GCA, they need to be aware of, they need to monitor. In the case of occurrence, they need to actually quickly discuss them with their treating physician and seek care. And then we talk about glucocorticoid-related complications, which healers specifically targeted to rheumatology. This is preaching to the choir, particularly on this. But although with some debate, as I mentioned initially, patients who live with PMR are sometimes exposed to glucocorticoids for several years, way more than we would expect, way more than we would want patients. And although some of these patients might remain on glucocorticoids at lower doses, we know that even those low doses can be associated with glucocorticoid-related toxicity such as bone health and osteoporosis and fractures, even more important in the population that would be at higher risk for falls.

We also think of, of course, of other glucocorticoid-related toxicity such as increased risk of diabetes or hypertension, or associated, of course, to weight gain and some other issues. Even the low doses can be associated to infections. And there's a nice study that actually shows that in patients with PMR, even doses below five milligrams daily can increase the risk of infections and hospitalizations. This is, of course, no surprise given that this has also been shown in older adults with rheumatoid arthritis. So glucocorticoid toxicity tends to be also a big issue. I'm also kind of ignoring probably cataracts and a bunch of, again, the never ending list of glucocorticoid toxicity, but that's the other kind of risk that comes with it. And specifically talking about kind of older adults who are burdened by joint pain that affects their mobility, this can also have an impact, again, in their quality of life with regards to increasing risk of falls. Decreased mobility is also associated to kind of other issues such as like, again, impacting quality of life, depression, and so forth. So there's several other kind of issues that can arise in this population.