Partington, Richard James ORCID: https://orcid.org/0000-0002-7362-0257 (2019) An epidemiological investigation into the incidence, prevalence, treatment and comorbidities associated with polymyalgia rheumatica in the United Kingdom 1990-2015. Doctoral thesis, Keele University.

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Abstract

Background Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease that affects older people. It can cause stiffness, severe pain and significant impairment to daily activities. Glucocorticoids (GCs) remain the mainstay of treatment. Contemporary estimates of the incidence and prevalence are lacking, and no previous study has assessed treatment patterns at a population level. Patients with a diagnosis of PMR may have an increased risk of comorbidities such as vascular disease or cancer, and the effect of PMR on mortality is uncertain.
Methods
This thesis contained results from a series of observational studies of PMR. The data sources included the Clinical Practice Research Datalink, Hospital Episode Statistics and Office of National Statistics Death registration datasets. A range of outcomes was assessed, including incidence, prevalence, treatment, comorbidities, hospital admissions and mortality.
Results
This study estimated that, in patients aged over 40 years, the prevalence and incidence of PMR in the UK was 0.85% and 95.9 per 100,000 respectively. Median (IQR) continuous glucocorticoid (GC) treatment duration was 15.8 (7.9, 31.2) months. However, around 25% of patients received more than four years total therapy. Patients with a diagnosis of PMR had a greater burden of comorbid disease compared to matched controls, and were more likely to be diagnosed with vascular, respiratory, renal, autoimmune, endocrine and psychiatric diseases. However, they were less likely to be diagnosed with cancer or dementia. Despite these differences, PMR had a neutral effect on all-cause mortality.
Conclusions
PMR is a common inflammatory rheumatological disease, affecting 1 in 120 adults aged over 40 years. Incidence is stable. Management of PMR largely followed guidelines, but there was a subset of patients subject to prolonged GC therapy. Although, compared to matched controls, patients with PMR have a slightly different profile of comorbid disease, no difference in mortality was observed.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > RC Internal medicine > RC927 Rheumatism
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Contributors: Sultan, AA (Thesis advisor)
Helliwell, T (Thesis advisor)
Mallen, CD (Thesis advisor)
Muller, S (Thesis advisor)
Depositing User: Lisa Bailey
Date Deposited: 08 Nov 2019 12:46
Last Modified: 08 Nov 2019 12:56
URI: https://eprints.keele.ac.uk/id/eprint/7160

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