Study Finds Declining Polymyalgia Rheumatica Incidence and Prolonged Steroid Use

A nationwide Danish cohort study found a 12% decline in age-standardized polymyalgia rheumatica (PMR) incidence from 2003 to 2024 and prolonged glucocorticoid use in a subgroup of patients. The study was accepted for publication in Arthritis & Rheumatology.

Investigators used linked national registers to identify more than 51,000 adults aged 50 years or older across primary and secondary care. Cases were identified between January 1, 2003, and November 1, 2024, using algorithms incorporating prescription records and, in secondary care, diagnostic codes. Median age was 74 years, and 57% were women.

The overall age-standardized incidence was 112 per 100,000 people aged 50 years or older. The decline in primary-care incidence exceeded a 30% increase in secondary-care incidence. Rates were highest among adults aged 80 to 84 years. Giant cell arteritis occurred after PMR diagnosis at 5.4 cases per 1,000 patient-years, with 68.2% of cases identified within the first year.

The estimated cumulative proportion discontinuing prednisolone or prednisone reached 72.0% at five years and 78.1% at ten years, accounting for death as a competing risk. Patients identified in primary care discontinued treatment sooner than those identified in secondary care. During follow-up, 10.2% redeemed at least one methotrexate prescription.

The authors noted that incidence may have been underestimated because the algorithms missed patients managed by private rheumatologists. Giant cell arteritis could also have been underreported or initially unrecognized. Treatment duration was inferred from prescription redemptions, with the end of a case defined as nine months after the last redemption; alternative definitions changed estimated disease duration.

Source: Donskov AO, Hauge EM, De Thurah A, Nørgaard M, Keller KK. Incidence and disease course of polymyalgia rheumatica during two decades: a nationwide study across healthcare sectors in Denmark. Arthritis Rheumatol. 2026. doi:10.1002/art.70337