VIDEO: ‘We need to do better’ with polymyalgia rheumatica awareness

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So this is a work in progress and we need to do better on this, but I think first things first, we need to really ensure a better communication between specialists and non-specialists. I think our UK colleagues have actually really taken the lead on this with joint guidelines with the equivalent to a family medicine physician in the UK. And that has also kind of raised a lot of awareness, better understanding of what treatment should be, when do patients need to be referred, and actually having a standard of treatment that is joined between specialists and non-specialists, which I don't think it's the case nowadays. We have global survey that was published last year, yes, last year, actually showed a lot of variability between some of the practices among different regions, including just what is the starting dose of corticosteroids between specialists and non-specialists.

So there's a need to better communicate between this, because unlike a lot of our other rheumatic diseases, I think every single patient with a rheumatic disease has a primary care physician. But like a lot of other rheumatic diseases, bulk of patients, a big burden of the patients with PMR are taking care of in the primary care setting. However, research happens and research gets developed in the specialty setting and translating this into our non-rheumatology colleagues is something that we need to improve. And this was, again, translates as well into patients and with this point also education and updates on what is the current state of PMR, what are the current kind of treatment duration in PMR, what options exist? Because the fact is that I think there's a lot of misconceptions around this disease. I think with the most common one being that you treat it and it goes away, when we know that the majority of patients with PMR experience relapse and we know the fact that there's not a ideal treatment duration for PMR. There's significant variability between one patient and another other. And some patients do require glucocorticoid treatment due to active inflammatory disease for years. So there is a need to, again, education to come with this and not to stay within the specialty world.

Other challenges to the care of PMR as well, I think one, having already voiced my kind of geriatric inclinations and an interest, is that I think ageism is a big issue. We know, and we've seen some data in older adults with RA that show that for some reason, older adults do not get necessarily started on glucocorticoid sparing agents or DMARDs as one would expect for a younger patient. Ageism has a role in this and I think it probably happens frequently in PMR where people expect, and this comes probably from not only, both from patient side providers, are where people are expect to hurt, where people are concerned about taking medicines, and those concerns can really affect decision making from all stakeholders involved. PMR is not normal kind of condition of aging. It is associated to aging, but it's not, and I think treatment is certainly important, demystifying ageism around this and other conditions that affect older adults is important as well.