From the Guidelines
Polymyalgia rheumatica (PMR) does increase the risk of pulmonary embolism (PE), as indicated by the presence of autoimmune diseases as a moderate risk factor for venous thromboembolism in the 2020 European Society of Cardiology guidelines 1. Patients with PMR have an increased risk of developing PE compared to the general population, particularly during the first year after diagnosis. This increased risk is likely due to several factors:
- the inflammatory state associated with PMR increases blood coagulability;
- reduced mobility in affected patients leads to blood stasis;
- and the corticosteroid treatment commonly used for PMR (typically prednisone starting at 15-20mg daily with gradual tapering over months) may further increase thrombotic risk, as suggested by the 2015 systematic literature review informing the European League Against Rheumatism/American College of Rheumatology recommendations for the management of PMR 1. Patients with PMR should be monitored for symptoms of PE such as sudden shortness of breath, chest pain, rapid heartbeat, or coughing up blood. Those with additional risk factors for thromboembolism (such as advanced age, obesity, history of previous clots, or immobility) should be especially vigilant. While routine anticoagulation prophylaxis is not standard practice for all PMR patients, physicians may consider it in high-risk individuals, as suggested by the 2020 ESC guidelines for the diagnosis and management of acute pulmonary embolism 1. Maintaining mobility through appropriate exercise within pain limitations and ensuring adequate hydration may help reduce PE risk in PMR patients. Key points to consider in the management of PMR patients include:
- Monitoring for symptoms of PE
- Identifying additional risk factors for thromboembolism
- Considering anticoagulation prophylaxis in high-risk individuals
- Encouraging mobility and adequate hydration to reduce PE risk.
From the Research
Risk of Pulmonary Embolism (PE) in Polymyalgia Rheumatica (PMR)
- The risk of PE in patients with PMR is a significant concern, as evidenced by a study published in the Journal of Internal Medicine 2.
- This study found that patients with PMR had a higher risk of developing PE compared to patients with osteoarthritis (OA), with a hazard ratio (HR) of 1.55 (95% confidence interval [CI]: 1.1-2.18, p = 0.01) when compared to patients with giant cell arteritis (GCA) 2.
- However, the study also noted that the risk of thromboembolic events, including PE, differs between GCA, PMR, and overlapping diseases, suggesting that PMR may not be the primary driver of increased PE risk 2.
- Other studies have focused on the treatment and management of PMR, highlighting the importance of glucocorticosteroids (GC) and the need for novel therapeutic strategies to reduce morbidity associated with GC-based regimens 3.
- Additionally, research has explored the association between PMR and lung involvement, although this is considered an unusual occurrence 4.
- The treatment of PE itself has been studied extensively, with low-molecular-weight heparin (LMWH) and rivaroxaban emerging as effective and safe options for anticoagulant therapy 5, 6.