From the Guidelines
Polymyalgia Rheumatica (PMR) is associated with an increased risk of cardiovascular disease, including cardiac issues such as heart failure, myocarditis, and pericarditis, due to chronic inflammation and other mechanisms 1. The relationship between cardiac issues and PMR is complex, with multiple factors contributing to the increased risk of cardiovascular disease in patients with PMR.
- Chronic inflammation is thought to play a key role in the development of cardiovascular disease in PMR, with elevated levels of C-reactive protein, interleukin 6, and tumor necrosis factor-α linked to an increased risk of heart failure and mortality 1.
- The presence of persistently elevated erythrocyte sedimentation rate levels, RA vasculitis, or RA lung disease is independently associated with worse mortality in patients with PMR and heart failure 1.
- Treatment of PMR with steroids can increase the risk of heart failure, while disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and tumor necrosis factor inhibition may reduce the risk of incident heart failure 1, 2.
- A comprehensive approach to managing cardiovascular risk in PMR patients is necessary, including lipid management, hypertension treatment, and education on risk factor modification 2.
- The use of statins, beta-blockers, and antiplatelet therapy may be beneficial in reducing cardiovascular risk in PMR patients, although the optimal treatment strategy is not yet clear 2.
- A multidisciplinary approach, including collaboration between rheumatologists, cardiologists, and PMR specialists, is essential for optimizing outcomes in PMR patients with cardiac issues.
- The goal of treatment should be to reduce inflammation, manage cardiovascular risk factors, and improve quality of life, with a focus on minimizing morbidity and mortality.
- Further research is needed to fully understand the relationship between PMR and cardiac issues, and to develop evidence-based guidelines for managing cardiovascular risk in PMR patients.
From the Research
Relationship Between Cardiac Issues and Polymyalgia Rheumatica (PMR)
There is no direct evidence in the provided studies to suggest a relationship between cardiac issues and Polymyalgia Rheumatica (PMR).
Treatment and Management of PMR
- The primary treatment for PMR is glucocorticoids, with an initial dose of prednisone of 10-20 mg/day yielding clinical improvement in the majority of patients 3.
- Methotrexate is the most commonly used corticosteroid sparing agent 3.
- Biologic agents, such as tocilizumab and sarilumab, have demonstrated efficacy in reducing relapse frequency, lowering the cumulative glucocorticoid burden, and achieving long-term remission of the disease 4, 5.
- Janus kinase (JAK) inhibitors are currently under investigation as a potential treatment for PMR 4, 5.
Patient Priorities for PMR Management
- A survey of PMR patients found that priority research areas were focused on how to better manage pain, stiffness and fatigue, improving the diagnosis of PMR, and steroid management 6.
Glucocorticoid Treatment
- Glucocorticoids are associated with side effects, and tapering or discontinuation of glucocorticoids often leads to disease relapses 4.
- The use of glucocorticoid-sparing agents, such as methotrexate and biologics, can help reduce the cumulative glucocorticoid burden and achieve long-term remission of the disease 4.