ADVERSE OUTCOMES OF ANTIINFLAMMATORY THERAPY AMONG PATIENTS WITH POLYMYALGIA-RHEUMATICA

Objective. To evaluate the incidence and risks of adverse events assoc iated with therapy (both corticosteroids [CS] and nonsteroidal antiinf lammatory drugs [NSAIDs]) among a previously identified, population-ba sed cohort of patients first diagnosed with polymyalgia rheumatica (PM R) between 1970 and 1991 who were followed up over the long term, Meth ods. Information on demographics, PMR diagnosis, disease course, and d rug therapy, in addition to data on adverse events commonly associated with CS and NSAID treatment, was obtained from the Rochester Epidemio logy Project database, Cox proportional hazards and regression analysi s models were used to evaluate the relationship between the occurrence of these events and therapy, Results. Of the 232 patients (69 male, 1 63 female) included in the study, the mean age at PMR diagnosis was 72 .9 years, the average followup was 8.0 years, and 30 patients were als o diagnosed with giant cell (temporal) arteritis, Among the 175 patien ts (49 male, 126 female) treated with CS, the mean duration of CS ther apy was 2.4 years, the average daily dose was 9.6 mg, and the mean cum ulative dose was 8.4 gm. In total, 65% of the 124 patients treated wit h CS alone experienced at least 1 adverse event, compared,vith 67% of the 57 patients treated with NSAIDs alone and 80% of the 51 patients t reated with CS and NSAIDs. The average time from initiation of therapy to the first adverse event was 1.6 years (n = 160), Proportional haza rds modeling identified 3 variables that independently increased the r isk of adverse events: age at PMR diagnosis, a cumulative dose of pred nisone greater than or equal to 1,800 mg, and female sex, Person-year analysis revealed that the risks of diabetes mellitus, vertebral fract ures, femoral neck fractures, and hip fractures were 2-5 times greater among PMR patients compared with age-and sex-matched individuals from the same population, Medical care or consultation by a rheumatologist was a highly significant predictor of a lower initial CS dose. Conclu sion. The use of CS and NSAIDs in the treatment of PMR is associated w ith important longterm morbidity.