Polymyalgia rheumatica and vertebral fractures: a 1-year pilot controlled study

Luigi Calvo (1) , Giovanni Pistone (2) , Sabrina Arnone (3) , Daniela Colomba (1) , Salvatore Amico (1) , Antonella Giacalone (3) , Pietra Vitale (2) , Calogero Nicosia (2) , Eliana Barone (1) , Rosario Scaglione (1) , Giuseppe Licata (1) , Salvatore Corrao (1)

1 Dipartimento Biomedico di Medicina Interna e Specialistica
2 Outpatient Rheumatologic Clinic
3 Unit of Clinical Methodology, Epidemiology and Statistics

No data exist about the possibility that vertebral fracture in PMR patients could be independent of steroid therapy. For this reason, we aimed to investigate this topic by a case cohort study with a 1-year follow-up for each patient. We selected ten consecutive patients who experienced vertebral fractures (VF-group) during the first month of 1-year follow-up period and without any other significant associated condition. As a control group we studied ten control patients, without vertebral fractures and with a follow-up of 1 year, randomly selected among a larger group of patients affected by polymyalgia rheumatica. The following data were analysed: eritrosedimention rate (ESR), visual analogical scale score (VAS), methyprednisolone daily dosage. Each patient had been monthly evaluated by the aforementioned clinical and laboratoristic parameters during the 1-year follow-up period. The VF-group resulted with a higher and statistically significant median corticosteroid 12-month total dosage [mean 3,480 mg (95%CI 2,805–3,030) vs. 2,760 mg (2,666.25–3,247.5)]. The VF-group had statistically significant higher ESR and VAS AUC when compared to control group (median ESR AUC, 484.75 vs. 288.25;  = 0.0001; median VAS AUC, 70.75 vs. 43.5  < 0.0001); ESR at the baseline (cut-off >80 mm) showed a specificity of 90% (95%CI 56–100) and sensitivity of 70% (95%CI 35–93). VAS difference from first to second month (cut-off ≤3) showed a specificity of 90% (95%CI 56–100) and sensitivity of 80% (95% CI 44–97). Our results point out that vertebral fracture might be predicted from commonly used laboratory (ESR) and clinical (VAS) findings.

Mots clés: Polymyalgia rheumatica; Vertebral fractures; Osteoporosis; Controlled clinical trial

Luigi Calvo, Giovanni Pistone, Sabrina Arnone, Daniela Colomba, Salvatore Amico, et al.. Polymyalgia rheumatica and vertebral fractures: a 1-year pilot controlled study. Rheumatology International, 2010, 30 (9), pp.1245-1247. ⟨10.1007/s00296-010-1399-0⟩. ⟨hal-00578289⟩