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Donskov AO, Mackie SL, Hauge EM, Toro-Gutiérrez CE, Hansen IT, Hemmig AK, Van der Maas A, Gheita T, Nielsen BD, Douglas KMJ, Conway R, Rezus E, Dasgupta B, Monti S, Matteson EL, Sattui SE, Matza M, Ocampo V, Gromova M, Grainger R, Bran A, Appenzeller S, Goecke A, Colman N, Keen HI, Kuwana M, Gupta L, Salim B, Harifi G, Erraoui M, Ziade N, Al-Ani NA, Ajibade A, Knitza J, Frølund L, Yates M, Pimentel-Quiroz VR, Lyrio AM, Sandovici M, Van der Geest KSM, Helliwell T, Brouwer E, Dejaco C, Keller KK. An international survey of current management practices for polymyalgia rheumatica by general practitioners and rheumatologists. Rheumatology (Oxford) 2023:6986973. [PMID: 36637182 DOI: 10.1093/rheumatology/keac713] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To explore current management practices for polymyalgia rheumatica (PMR) by general practitioners (GPs) and rheumatologists including implications for clinical trial recruitment. METHODS An English language questionnaire was constructed by a working group of rheumatologists and GPs from 6 countries. The questionnaire focused on: 1: Respondent characteristics, 2: Referral practices, 3: Treatment with glucocorticoids, 4: Diagnostics, 5: Comorbidities, and 6: Barriers to research. The questionnaire was distributed to rheumatologists and GPs worldwide via members of the International PMR/giant cell arteritis Study Group. RESULTS In total, 394 GPs and 937 rheumatologists responded to the survey. GPs referred a median of 25% of their suspected PMR patients for diagnosis and 50% of these were returned to their GP for management. In general, 39% of rheumatologists evaluated patients with suspected PMR >2 weeks after referral, and a median of 50% of patients had started prednisolone before rheumatologist evaluation. Direct comparison of initial treatment showed that the percentage prescribing >25 mg prednisolone daily for patients was 30% for GPs and 12% for rheumatologists. Diagnostic imaging was rarely used. More than half (56%) of rheumatologists experienced difficulties recruiting people with PMR to clinical trials. CONCLUSION This large international survey indicates that a large proportion of people with PMR are not referred for diagnosis, and that the proportion of treatment naïve patients declined with increasing time from referral to assessment. Strategies are needed to change referral and management of people with PMR, to improve clinical practice and facilitate recruitment to clinical trials.
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Affiliation(s)
| | - Sarah Louise Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ellen Margrethe Hauge
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Ib Tønder Hansen
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Tamer Gheita
- Rheumatology and Clinical Immunology, Cairo University, Cairo, Egypt
| | | | - Karen M J Douglas
- Department of Rheumatology, Dudley Group NHS FT, Dudley, United Kingdom
| | - Richard Conway
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Elena Rezus
- Department of Rheumatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University Hospital, Southend, United Kingdom
| | - Sara Monti
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia.,Department of Internal Medicine and Therapeutics, Università di Pavia
| | - Eric L Matteson
- Mayo Clinic College of Medicine and Science, Division of Rheumatology, Rochester, United States of America
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark Matza
- Rheumatology Unit, Massachusetts General Hospital, Boston, United States of America
| | - Vanessa Ocampo
- University of Toronto - Center for Prognosis studies in Rheumatic Diseases, Toronto Western Hospital. Rheumatology Department -Scarborough Health Network and Kensington Eye Institute. Toronto, Canada
| | - Margarita Gromova
- Faculty therapy, Pirogov National Russian Research Medical University, Moscow, Russian Federation
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Andrea Bran
- Department of medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology-School of Medical Science, University of Campinas, Campinas, Brazil
| | - Annelise Goecke
- Rheumatology Section, Department of Medicine, University of Chilés Clinical Hospital, Santiago, Chile
| | - Nelly Colman
- Universidad Nacional de Asunción, Hospital de Clinicas, Asunción, Paraguay
| | - Helen I Keen
- Medical School, UWA, Perth Australia, Rheumatology Department, Fiona Stanley Hospital, Perth, Australia
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School, Tokyo, Japan
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospital NHS Trust, Wolverhampton, United Kingdom.,Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Babur Salim
- Fauji Foundation Hospital Rawalpindi, Rheumatology, Rawalpindi, Pakistan
| | - Ghita Harifi
- Mediclinic Parkview Hospital, Dubai Health Authority, Rheumatology, Dubai, United Arab Emirates
| | - Mariam Erraoui
- Ibn Zohr University, Faculty of Medicine and Pharmacy, Department of Rheumatology, Agadir, Morocco
| | - Nelly Ziade
- Rheumatology, Saint-Joseph University, Beirut, Lebanon
| | | | - Adeola Ajibade
- Department of Rheumatology, Royal Wolverhampton Hospital NHS Trust, Wolverhampton, United Kingdom.,Rheumatology Unit, Internal Medicine Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Johannes Knitza
- Friedrich-Alexander-University ErlangenNürnberg (FAU) and Universitätsklinikum Erlangen, Medizinische Klinik 3, Erlangen, Germany
| | - Line Frølund
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark
| | - Max Yates
- Centre for Epidemiology, Norwich Medical School, University of East Anglia, NR4 7UQ, United Kingdom.,Department of Rheumatology, Norfolk and Norwich University Hospital, NR4 7UY, United Kingdom
| | - Victor R Pimentel-Quiroz
- Department of Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.,Universidad Científica del Sur, Lima, Perú
| | - Andre Marun Lyrio
- Department of general medicine/Rheumatology, Pontifical Catholic University of Campinas, Campinas, Brazil
| | - Maria Sandovici
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kornelis S M Van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Toby Helliwell
- Staffordshire, University of Staffordshire, School of Medicine, United Kingdom
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria.,Rheumatology, Hospital of Bruneck (SABES-ASAA), Bruneck, Italy
| | - Kresten Krarup Keller
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Donskov AO, Shimada A, Vinge L, Svensson P, Andersen H. Oral function in patients with myasthenia gravis. PeerJ 2021; 9:e11680. [PMID: 34249511 PMCID: PMC8253106 DOI: 10.7717/peerj.11680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/04/2021] [Indexed: 11/25/2022] Open
Abstract
Myasthenia Gravis (MG) is characterised by muscle weakness and increased fatigability. The aim of this pilot study was to investigate if patients with MG demonstrate different functional chewing patterns and report more complaints related to mastication as compared with healthy controls. Twelve patients (median 60 years Q1–Q3: 46–70) with generalised MG and nine healthy controls (median 57 years Q1–Q3: 55–63) participated. All participants underwent dental and oral examination and were asked to fill in a questionnaire concerning oral health. Static maximum bite force was measured with a bite force transducer, electromyography in the masseter, temporalis, and suprahyoid muscles were recorded, and jaw movement was tracked, during a 5-minute gum chewing test. The patients had more oral complaints (oral health impact profile total score 22.6 vs 7.5 P < 0.01) and had lower peak bite force than controls (18.8kgf (11.1;26.4) (95% CI) vs 29.5 kgf (21.6; 37.4) (P = 0.04)). In contrast, fatigability of the masticatory muscles, as defined by number of chewing cycles during the gum-chewing test, did not differ between patients and controls (P = 0.10). In conclusion, patients had more oral complaints and lower bite force than controls, but did not show significantly different functional chewing patterns. Future studies should aim at integrating measurement of peak force into functional tests. Attention should be given to oral complaints of patients with MG.
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Affiliation(s)
| | - Akiko Shimada
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
| | - Lotte Vinge
- Department of Neurology, Aarhus University Hospital, Aarhus, Region midt, Denmark
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Faculty of Odontology, MalmøUniversity, Sweden
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Region midt, Denmark
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