The effect of a nurse-led prednisolone tapering regimen in polymyalgia rheumatica: a retrospective cohort study

Abstract

The objective of this study is to investigate the efficacy of a nurse-led prednisolone tapering regime in patients with polymyalgia rheumatica (PMR) compared to standard care. It is a single-center retrospective cohort study evaluating dose and percentage of patients receiving prednisolone after 1 and 2 years. A nurse-led PMR clinic was introduced June 2015 and patients diagnosed until June 2017 were included. Patients were diagnosed by a rheumatologist, and subsequently managed by nurses according to a specific protocol. Patients diagnosed with PMR between June 2012 and June 2015 served as controls. They received standard care by a rheumatologist. Sixty-eight patients received standard care and 107 nurse-led care. After 1 year, 71% of patients receiving standard care vs. 64% receiving nurse-led care took prednisolone (p = 0.441). Median (interquartile range) prednisolone dose after 1 year was 3.75 mg (0–5) in the standard care group and 1.25 mg (0–3.75) in the nurse-led care group (p = 0.004). After 2 years, 41% of patients receiving standard care vs. 18% receiving nurse-led care took prednisolone (p = 0.003). Prednisolone dose after 2 years was 0 mg (0–2.5) in the standard care group and 0 mg (0–0) in the nurse-led care group (p = 0.004). There was no difference regarding relapse and initiation of methotrexate. The number of patient contacts was 12.5 (5–16.5) in the standard care group vs. 17 (13–23) in the nurse-led care group (p = 0.001). A tight and systematic approach to prednisolone tapering is more effective than standard care, but more frequent patient contacts were necessary to obtain this effect.

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Acknowledgements

The authors are grateful for the excellent help of Andrew Bolas with data management.

Funding

No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

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Contributions

All authors contributed to the study conception, design and data collection. Analysis was performed by KKK and CM. The first draft of the manuscript was written by KK and CM. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kresten K. Keller.

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All authors report no conflicts of interest.

Ethical approval

The study was approved by the Danish Data Protection Agency (case number 1-16-02-295-18, approval date 30.10.2018) and the Danish Patient Safety Authority (case number 3-3013-2689/1, approval date 22.06.2018).

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Congress abstracts: This work has been published as an abstract for the EULAR 2020 congress (Ann Rheum Dis, volume 79, supplement 1, year 2020, page 859).

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Mørk, C., Dam, M.Y., Callsen, M.G. et al. The effect of a nurse-led prednisolone tapering regimen in polymyalgia rheumatica: a retrospective cohort study. Rheumatol Int 41, 605–610 (2021). https://doi.org/10.1007/s00296-020-04654-w

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Keywords

  • Polymyalgia rheumatica
  • Prednisolone
  • Nurse-led care
  • Tapering regimen