Frequency, diagnosis, and management of polymyalgia rheumatica in Germany - Database analysis of medical insurance data

Abstract

Objectives Epidemiological data on polymyalgia rheumatica (PMR) in Germany is limited. Current national prevalence estimates are low by international standards. This study aimed to gain up-to-date data representative of Germany. Methods A cross-sectional analysis was conducted on a sample of 4.8 million insured individuals, representative of the German population, from the InGef (Institute for Health Research Berlin GmbH) research database. Inclusion criteria were age ≥50 years, continuous insurance status for a base period of 3 years and for the subsequent 2 years for longitudinal analysis. Results were additionally extrapolated to the German population. Results Each year from 2018 to 2021, around 1.7 million insured individuals were included in the study. Extrapolated to the German population in 2021, the incidence was 111/100 000 and the prevalence was 937/100 000. Diagnosis was made predominantly in outpatient settings (86.7%) most frequently by general practitioners (GP; 37.1%), internists (22.2%), rheumatologists (11.4%) and orthopaedists (10.2%). An additional 21% were referred to rheumatologists for treatment after diagnosis. Treatment was most commonly initiated by GPs, followed by rheumatologists, and included methotrexate in 19.8%. Most common comorbidities of prevalent patients comprised arterial hypertension (75.9%), dyslipidaemia (55.0%), diabetes mellitus (29.7%), osteoporosis (27.1%), coronary heart disease (23.4%) and cataract (24.3%). Conclusion This analysis revealed that PMR occurs more frequently in individuals aged 50 or older in Germany than previously assumed. Diagnosis is primarily made in general practice settings, with about one-third of patients being treated by rheumatologists. Comorbidities such as diabetes mellitus or cardiovascular diseases are common in the prevalent population.