OBJECTIVE: To describe the use of generalist and rheumatologist services in a population-based cohort of patients with polymyalgia rheumatica (PMR) and to identify predictors of rheumatology care. METHODS: We identified all incident cases of PMR among residents of Olmsted County, Minnesota between 1970 and 1999. Patients were followed for a maximum of 5 years after their incidence date. Logistic regression and zero-inflated Poisson regression models were used to assess the association between rheumatology care and age, sex, giant cell arteritis (GCA), PMR relapses, corticosteroid complications, comorbidity, and various laboratory findings, adjusting for the total number of visits. RESULTS: Of the 364 incident cases of PMR eligible for this analysis, 67% were women and the mean age at incidence was 73 years. Over a mean followup of 4.1 years, individuals in this cohort utilized a total of 5,108 physician office visits and 2,015 telephone calls. The mean number of generalist and rheumatologist visits per person-years of follow-up during the first year of PMR was 7.02 and 2.15, respectively. Thereafter, there was a steady decline in both generalist and rheumatologist visits. One hundred forty-four (40%) patients had no rheumatologist visits and 102 (28%) had only 1 rheumatologist visit, mostly for diagnostic confirmation. Men and patients with several comorbid conditions were significantly more likely to be seen by rheumatologists (P < 0.001). However, once referred, women, older patients, and those with GCA, PMR relapses, and corticosteroid complications had significantly more rheumatologist visits (P < 0.001). CONCLUSION: The use of physician services in PMR is considerable. Generalists provide the large majority of care. Rheumatologist involvement is generally limited to diagnostic confirmation and management of complications. The relative paucity of rheumatology care following the period of diagnosis may represent an opportunity for improving the care of patients with PMR.
OBJECTIVE: To describe the use of generalist and rheumatologist services in a population-based cohort of patients with polymyalgia rheumatica (PMR) and to identify predictors of rheumatology care. METHODS: We identified all incident cases of PMR among residents of Olmsted County, Minnesota between 1970 and 1999. Patients were followed for a maximum of 5 years after their incidence date. Logistic regression and zero-inflated Poisson regression models were used to assess the association between rheumatology care and age, sex, giant cell arteritis (GCA), PMR relapses, corticosteroid complications, comorbidity, and various laboratory findings, adjusting for the total number of visits. RESULTS: Of the 364 incident cases of PMR eligible for this analysis, 67% were women and the mean age at incidence was 73 years. Over a mean followup of 4.1 years, individuals in this cohort utilized a total of 5,108 physician office visits and 2,015 telephone calls. The mean number of generalist and rheumatologist visits per person-years of follow-up during the first year of PMR was 7.02 and 2.15, respectively. Thereafter, there was a steady decline in both generalist and rheumatologist visits. One hundred forty-four (40%) patients had no rheumatologist visits and 102 (28%) had only 1 rheumatologist visit, mostly for diagnostic confirmation. Men and patients with several comorbid conditions were significantly more likely to be seen by rheumatologists (P < 0.001). However, once referred, women, older patients, and those with GCA, PMR relapses, and corticosteroid complications had significantly more rheumatologist visits (P < 0.001). CONCLUSION: The use of physician services in PMR is considerable. Generalists provide the large majority of care. Rheumatologist involvement is generally limited to diagnostic confirmation and management of complications. The relative paucity of rheumatology care following the period of diagnosis may represent an opportunity for improving the care of patients with PMR.
Authors: Hilal Maradit Kremers; Elena Myasoedova; Cynthia S Crowson; Guergana Savova; Sherine E Gabriel; Eric L Matteson Journal: Rheumatology (Oxford) Date: 2010-07-13 Impact factor: 7.580
Authors: Deana D Hoganson; Cynthia S Crowson; Kenneth J Warrington; Sherine E Gabriel; Eric L Matteson Journal: Int J Rheum Dis Date: 2010-08 Impact factor: 2.454
Authors: Sarah L Mackie; Helen Twohig; Lorna M Neill; Eileen Harrison; Beverley Shea; Rachel J Black; Tanaz A Kermani; Peter A Merkel; Christian D Mallen; Frank Buttgereit; Chetan Mukhtyar; Lee S Simon; Catherine L Hill Journal: J Rheumatol Date: 2017-08-01 Impact factor: 4.666
Authors: Christian Dejaco; Christina Duftner; Marco A Cimmino; Bhaskar Dasgupta; Carlo Salvarani; Cynthia S Crowson; Hilal Maradit-Kremers; Andrew Hutchings; Eric L Matteson; Michael Schirmer Journal: Ann Rheum Dis Date: 2010-11-19 Impact factor: 19.103
Authors: Bhaskar Dasgupta; Marco A Cimmino; Hilal Maradit-Kremers; Wolfgang A Schmidt; Michael Schirmer; Carlo Salvarani; Artur Bachta; Christian Dejaco; Christina Duftner; Hanne Slott Jensen; Pierre Duhaut; Gyula Poór; Novák Pál Kaposi; Peter Mandl; Peter V Balint; Zsuzsa Schmidt; Annamaria Iagnocco; Carlotta Nannini; Fabrizio Cantini; Pierluigi Macchioni; Nicolò Pipitone; Montserrat Del Amo; Georgina Espígol-Frigolé; Maria C Cid; Víctor M Martínez-Taboada; Elisabeth Nordborg; Haner Direskeneli; Sibel Zehra Aydin; Khalid Ahmed; Brian Hazleman; Barbara Silverman; Colin Pease; Richard J Wakefield; Raashid Luqmani; Andy Abril; Clement J Michet; Ralph Marcus; Neil J Gonter; Mehrdad Maz; Rickey E Carter; Cynthia S Crowson; Eric L Matteson Journal: Ann Rheum Dis Date: 2012-04 Impact factor: 19.103
Authors: Toby Helliwell; Sara Muller; Samantha L Hider; Irena Zwierska; Sarah Lawton; Jane Richardson; Christian Mallen Journal: Br J Gen Pract Date: 2018-11 Impact factor: 5.386