Obesity impacts symptom severity, prednisone dosing in PMR

Obesity appears to have an impact on both symptom severity and the use of prednisone in patients with polymyalgia rheumatica (PMR), suggests a study. This is potentially driven by subjective pain perception rather than increased inflammation.

Twelve patients with obesity experienced significantly more shoulder pain (p=0.03), global pain (p=0.03), PMR visual analogue scale (VAS; p<0.01), and fatigue (p=0.03) at baseline. They also had higher modified Health Assessment Questionnaire (mHAQ) score (p=0.01) and lower 36-item Short Form Health Survey (SF-36) pain index (p<0.001).

The mean initial dosing of prednisone did not differ between BMI group, but patients with obesity were given a lower dose/kg (2.2 vs 1.9 mg; p<0.01).

At 6 months, patients with obesity received a higher mean daily prednisone dose (6.2 vs 8.5 mg/d; p=0.02) than those without obesity. Forty percent of patients with obesity were also treated with higher daily prednisone doses as opposed to only 14 percent of those without (p=0.048).

Both BMI groups had comparable clinical features, laboratory results, and girdle ultrasound results.

“BMI should be considered when interpreting symptoms in patients with PMR and deciding their prednisone doses,” the investigators said. 

This post hoc analysis involved 83 patients with recent-onset PMR, who were assessed for more than 6 months using clinical examination, laboratory evaluation, and girdle ultrasound.

Investigators recorded the mHAQ, SF-36, and PMR VAS, as well as prednisone therapy data. They grouped the participants based on their BMI.