Dataset Information

The risk of polymyalgia rheumatica in older adults with gout: a Medicare claims study.

ABSTRACT:

Objective

In the absence of previous studies, the objective was to assess whether gout is associated with a lower risk of PMR.

Methods

We used the 5% Medicare sample to assess whether gout in adults 65 years or older increases the risk of incident PMR. The main multivariable-adjusted model included age, gender, race, Charlson-Romano co-morbidity score, the use of medications for cardiovascular diseases (statins, β-blockers, diuretics, angiotensin-converting enzyme inhibitors) and gout (allopurinol, febuxostat). Hazard ratios and 95% CI were calculated.

Results

There were 11 744 cases of incident PMR, with crude incidence rates of PMR of 289/100 000 person-years in patients with gout and 109/100 000 person-years in patients without gout. People with incident PMR had a mean duration of gout of 2.2 years before PMR diagnosis (s.d., 1.6; median, 1.8; interquartile range, 0.8, 3.2). Multivariable-adjusted analyses showed that gout was associated with PMR with a hazard ratio of 2.45 (95% CI, 2.28, 2.64; P < 0.0001). Older age, female gender, White race and higher co-morbidity index were associated with a higher hazard of PMR. Sensitivity analyses that substituted continuous Charlson-Romano co-morbidity score with categorized score or individual co-morbidities (plus hypertension, hyperlipidaemia and coronary artery disease) confirmed the main findings with minimal attenuation of hazard ratio, 2.39 (95% CI, 2.22, 2.57; P < 0.0001) and 2.13 (95% CI, 1.98, 2.29; P < 0.0001), respectively.

Conclusion

Contrary to our hypothesis, gout was associated with >2-fold higher risk of incident PMR in older adults. Studies should explore whether inflammation or hyperuricaemia is the underlying mechanism for this association.

SUBMITTER: Singh JA

PROVIDER: S-EPMC6649982 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background and aimComorbidities are known to exist in many rheumatological conditions. Polymyalgia rheumatica (PMR) is a common inflammatory rheumatological condition affecting older people which, prior to effective treatment, causes severe disability. Our understanding of associated comorbidities in PMR is based only on case reports or series and small cohort studies. The objective of this study is to review systematically the existing literature on the comorbidities associated with PMR.MethodsMEDLINE, EMBASE, PsycINFO and CINAHL databases were searched for original observational research from inception to November 2016. Papers containing the words 'Polymyalgia Rheumatica' OR 'Giant Cell Arteritis' OR the terms 'PMR' OR 'GCA' were included. Article titles were reviewed based on pre-defined criteria by two reviewers. Following selection for inclusion, studies were quality assessed using the Newcastle-Ottawa tool and data were extracted.ResultsA total of 17,329 papers were reviewed and 41 were incorporated in this review, including three published after the search took place. Wide variations were found in study design, comorbidities reported and populations studied. Positive associations were found between PMR diagnosis and stroke, cardiovascular disease, peripheral arterial disease, diverticular disease and hypothyroidism. Two studies reported a positive association between PMR and overall malignancy rate. Seven studies reported an association between PMR and specific types of cancer, such as leukaemia, lymphoma, myeloproliferative disease and specified solid tumours, although nine studies found either no or negative association between cancer and PMR.ConclusionQuantification of the prevalence of comorbidities in PMR is important to accurately plan service provision and enable identification of cases of PMR which may be more difficult to treat. This review highlights that research into comorbidities in PMR is, overall, methodologically inadequate and does not comprehensively cover all comorbidities. Future studies should consider a range of comorbidities in patients with a validated diagnosis of PMR in representative populations.