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Background: The longitudinal outcomes, including cumulative glucocorticoid burden, relapse rate and use of steroid sparing agents in those with isolated Polymyalgia Rheumatica (PMR) are poorly understood, owing largely to the fact that in the majority of countries PMR is diagnosed and managed in primary care, with only a minority of cases referred for specialist evaluation.
Objectives: The aim of this study was to establish for the first time the longitudinal outcomes of an Irish cohort with isolated PMR.
Methods: Patients were recruited to this multi centre longitudinal cohort study from a newly established fast track PMR clinic in August 2022, where those fulfilling the 2012 EULAR/ACR provisional PMR classification criteria were invited to participate. Those with symptoms or imaging confirmation of cranial or large vessel giant cell arteritis were excluded. Those who had greater than 12 month follow- up were included in the final analysis. We defined relapse as a return in clinical symptoms and/or an elevation in acute phase reactants, necessitating and responsive to an increase in glucocorticoid dosage.
Results: A total of 66 patients (54.5% (36/66) females) were included with a mean age of 70.42 (SD 7.92) at the time of enrollment. 24 patients had 24-month follow-up, 29 patients had 18 month follow-up and a further 13 patients had 12 months follow-up. 54.5% (n=36) of patients experienced at least one relapse, with a total of 62 individual relapses. 18 patients had a single relapse, 12 had 2 relapses and 7 had 3 relapses. 74% (46/62) of the relapses occurred within the first 12 months with a mean time to relapse of 9.53 months (SD 5.59). 19% (12/62) occurred between 12-18 months, and a total of 4 relapses beyond 18 months. At the time of relapse, the mean steroid dose was 4.83mg (SD 3.96), with a mean CRP of 13.4 (SD 20.97) and ESR of 21.89 (SD 17.9). At 12 months, 33/66 (50%) were off therapy in clinical remission. In the total cohort (n=66) the mean cumulative steroid dose at 1 year was 2555.6mg (SD 831.995), with a mean current prednisolone dose of 1.715mg (SD 2.264). Of these 33 patients in clinical remission at one year, 4 subsequently relapsed over the following 6 months requiring further steroid therapy. All 4 were followed to 24 months, with only 1 remaining on glucocorticoids. 7/29 (24%) of patients with 18 month follow-up remained on glucocorticoids, with a mean dose of 0.82mg (SD 2.59) and a mean steroid burden of 2839.6mg (SD 1135.5). Notably, 5/7 (71%) of these were also on a steroid sparing therapy. In total 9/29 (31%) were on a steroid sparing agent of those with 18 month follow-up, with 69% (20/29) in clinical remission off therapy. 8% (2/24) patients followed to 24 months remained on GC therapy, with a mean dose of 0.36mg (SD 1.22). The mean cumulative steroid burden in these patients was 3097.2mg (SD 1204.3). 8/24 (33.3%) patients were on a steroid sparing agent, with 2/8 on steroid sparing agent and steroid. 58% (14/24) patients at 24 months were off treatment in clinical remission. In total 20 patients were exposed to the IL-6 inhibitor tocilizumab in this cohort. A total of 3 patients discontinued therapy, 1 of whom failed to tolerate the drug, and 2 of whom experienced a clinical flare after 3 months on established therapy. All 3 of these patients are now established on the IL-17 inhibitor secukinumab for > 3 months. A further 2 additional patients are on first line secukinumab as a steroid sparing agent due to contraindications to IL-6 antagonists.
Conclusion: This prospective study reports for the first time the longitudinal outcomes up to 24 months of an Irish PMR population, and emphasizes the disease and management burden, highlighting the importance of specialist input in the care of those with isolated PMR.
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (