gms | German Medical Science

Background and state of research: Polymyalgia rheumatica (PMR), an inflammatory rheumatologic disease, is frequently found in older adults. According to previous studies, women are at least twice as often affected by the disease than men. PMR is a clinical diagnosis without pathognomonic biomarkers, which often results in a prolonged diagnostic process involving different medical disciplines. The current S3-guideline gives recommendations for drug- and non-drug treatment of PMR. However, data about quality of care of patients with PMR in Germany are scarce.

Research question and objectives, hypothesis: The primary aim of this study was to outline the quality of care of patients with PMR by evaluating guideline adherence using claims data. A secondary aim was to examine possible differences between men and women.

Method: The study population of this retrospective cohort study comprised men and women at least 40 years of age with incident PMR between 2011 and 2020, who were insured with a German regional health care fund. Data from inpatient and outpatient care were included in the analysis. Guideline adherence was evaluated in terms of diagnostic procedures and assessments, specialist care, choice and course of treatment, and drug as well as non-drug treatment strategies. Differences between men and women were analyzed using descriptive statistical methods.

Results: A total of 27,079 patients with incident PMR between 2011 and 2020 were included in the study. The mean age was 69.9 years and 66.7% were women. In line with the S3-guideline, oral glucocorticoids constituted the primary drug therapy in patients with PMR and methotrexate or biologicals were administered in less than 10% of patients with PMR. Comorbidities such as diabetes mellitus, dyslipidemia, peptic ulcer and cardiovascular diseases were more often found in men, while women were more likely to present with cataract, glaucoma and previous infections. Almost all patients visited a GP in the first year after the incident diagnosis (99,7%). Ophthalmologists (54,3% vs. 49,2%), orthopedists (43,5% vs. 36,0%) and neurologists (10,3% vs. 8,6%) were more often frequented by women, while men were slightly more likely to visit rheumatologists than women (35,6% vs. 34,2%). Guideline-compliant follow-up visits in the two years after the incident diagnosis were more frequently found in women than in men.

Discussion: The preliminary results of this study showed that the majority of patients with incident PMR was treated according to current guideline recommendations. Sex-specific differences were detected in terms of comorbidities and follow-up visits, while the pharmacotherapy was similar in men and women.

Implication for care: Once the analysis of the current medical care situation of patients with PMR is finalized, the results can help to identify sex-specific measures to improve the quality of care for patients with PMR and develop post-graduate training modules for involved caregivers.

Funding: Other funding; Keine Fördernummer vorhanden (Projektförderung: AOK Baden-Württemberg)