NEW research highlights how obesity impacts the treatment and symptom severity of polymyalgia rheumatica (PMR), a common inflammatory condition in older adults marked by pain and stiffness. The study suggests that patients with obesity may experience more severe symptoms and require higher doses of glucocorticoids, such as prednisone, over time compared to those with a healthy weight.
In a post hoc analysis of 83 patients with newly diagnosed PMR, researchers evaluated symptoms, quality of life, and treatment regimens over six months. Patients with obesity reported significantly greater pain, fatigue, and physical limitations at baseline. Despite starting with similar prednisone doses, those with obesity received less medication per kilogram of body weight initially but required higher daily doses after six months to manage their symptoms.
Dr Marco A Cimmino, lead author of the study, noted, “Obesity appears to influence subjective pain perception and glucocorticoid requirements, but not inflammatory markers, in PMR patients. This suggests that weight plays a crucial role in both disease experience and treatment outcomes.”
By the six-month mark, 40% of patients with obesity were prescribed higher daily prednisone doses than the standard protocol, compared to only 14% of non-obese patients. However, clinical inflammation markers and ultrasound findings were similar across both groups, indicating that the heightened symptoms in patients with obesity may stem from altered pain perception rather than increased inflammation.
The findings underscore the importance of considering BMI when evaluating PMR symptoms and tailoring treatment plans. Clinicians should be mindful of the interplay between obesity and PMR to optimise patient care and avoid unnecessary dose escalation.
Aleksandra Zurowska, EMJ
Reference
Cimmino MA et al. Symptom Severity and Glucocorticoid Dosing in Patients With Polymyalgia Rheumatica and Obesity. J Rheum. 2024;DOI: https://doi.org/10.3899/jrheum.2024-0353.
