POS0321 CO-MORBIDITY IN POLYMYALGIA RHEUMATICA

Abstract

Background: Polymyalgia rheumatica (PMR) is the most common autoimmune musculoskeletal condition in the developed world, with UK prevalence of 1.7% in those aged older than 55 years. Current guidelines recommend glucocorti-coid treatment for one to two years. Since PMR affects older individuals and is associated with prolonged treatment with glucocorticoids, patients are at risk of developing or worsening co-morbidity. Objectives: This national study aimed to establish the prevalence of PMR from routinely recorded administrative care records from community-based primary care practices; secondly to calculate the most common comorbidities and their relative risk amongst those diagnosed with PMR. Methods: The ECLIPSE databased covers over 23m patients across 2400 general practices in England and provides insights for enhanced clinical pathway management and to support patient safety in primary care. Routinely recorded diagnoses from primary care data are updated daily, along with administrative prescribing data. Using standardised nationally agreed disease coding frameworks, all diagnoses of PMR were retrieved from the live patient population of 23.3m individuals registered with general practices across England. Comorbidity was recorded similarly. Diagnoses of PMR were categorised in 12-month bands since their date of diagnoses to examine the rates of prednisolone prescription by time since diagnosis. Results: Amongst the 23.3 million patient care records there were 146,252 diagnoses of PMR, resulting in a prevalence of 2.2% for those aged older than 55 years. The average age of those with PMR was 77.5 years. There were between 9863 to 11036 diagnoses of PMR made each year over the past five years. The proportion of those receiving prednisolone were highest amongst those most recently diagnosed: 76.4% for those in the last year; 48.4% for those diagnosed between a year and two years ago; 33.0% for those diagnosed between two to three years ago; 28.8% for those diagnosed between three to four years ago, and 24.9% for those diagnosed between four to five years ago. On average each patient with PMR had 3.5 co-morbid conditions and was prescribed 5.4 different medications. The top ten co-morbid conditions were, in rank order: hypertension (53.6%), osteoarthritis (48.6%), anxiety and depression (27.5%), chronic kidney disease (24.3%), type II diabetes (18.9%), ischaemic heart disease (14.9%), atrial fbrillation (13.7%), asthma (12.7%), COPD (7.9%), and heart failure (6.2%). Conclusion: Routinely recorded GP records provide prevalence estimates that are similar to previously published descriptive epidemiological studies, and despite guidelines recommending shorter courses of treatment, show the rates of prednisolone prescription remain high, years after diagnosis. Furthermore, due to the age of onset of PMR, this results in a patient population with high levels of co-morbidity many of whom are at increased risk due to prolonged glucocorticoid use. These data are crucial for developing risk stratifcation and population health management tools.