Veen, M.C.H. van der (2025) Glucocorticoid-sparing effect of methotrexate in polymyalgia rheumatica patients in a standard care cohort study. thesis, Medicine.
Full text available on request.Abstract
Objective: To investigate the glucocorticoid-sparing effect of methotrexate added to prednisone versus prednisone monotherapy and compare its impact on disease activity, relapse rates and quality of life in patients with polymyalgia rheumatica (PMR). Background: PMR is an inflammatory disease that primarily affects individuals over 50 years old, characterized by pain and stiffness and elevated inflammatory markers. Prednisone is the standard treatment, but long-term use can lead to significant side effects. Methotrexate has shown potential as a glucocorticoid-sparing agent in previous studies, though results have been inconsistent. Methods: This study included 55 PMR patients who met diagnostic criteria for PMR and had at least one year of follow-up (23 in the glucocorticoid + methotrexate group and 32 in the glucocorticoid group). Prednisone was started at 15–20 mg/day and methotrexate at 15 mg/week. Prednisone dosages, disease activity (PMR-AS), relapse rates and quality of life (SF-36) were analysed. Results: The GC + MTX group consistently showed a significantly lower cumulative prednisone dose at all time points (p<0.001). Both groups showed significant improved disease activity and quality of life over time, with no significant differences between the groups. Relapse rates were significantly higher in the GC + MTX group before MTX versus GC group (p=0,004), with a trend suggesting a higher relapse rate after the of start MTX (p=0,137). Conclusions: Methotrexate use in PMR patients led to a significant reduction in glucocorticoid use, suggesting a glucocorticoid-sparing effect. However, no significant difference was found in disease activity, overall quality of life or relapse rates. Further research is needed to confirm these findings and assess long-term outcomes.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Brouwer, prof. dr. E. |
| Faculty: | Medical Sciences |
| Date Deposited: | 13 May 2026 13:58 |
| Last Modified: | 13 May 2026 13:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3952 |
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