Influence of Sex on Glucocorticoid Toxicity Profiles in Polymyalgia Rheumatica
5 affiliations
- 1Division of Rheumatology, Department of Internal Medicine Mayo Clinic Scottsdale Arizona
- 2Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences Mayo Clinic Scottsdale Arizona
- 3Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota
- 4Division of Rheumatology, Department of Internal Medicine Mayo Clinic Rochester Minnesota
- 5Division of Pulmonary Medicine, Department of Internal Medicine Mayo Clinic Scottsdale Arizona
Abstract
Objective: Glucocorticoids (GCs) remain the primary treatment for polymyalgia rheumatica (PMR) but are associated with substantial long‐term toxicity. Although sex‐based differences in GC‐related adverse effects have been suggested, they have not been well studied in PMR.
Methods: We conducted a retrospective cohort study of patients with PMR treated between 2017 and 2024 within a multisite health system. Patients ≥50 years of age with at least two PMR International Classification of Diseases, Tenth Revision, codes and documented GC dosing for ≥75% of days during the first six months of treatment were included. Sex‐based differences in GC toxicity outcomes including incident or worsening hypertension, type 2 diabetes mellitus, and incidence of fragility fractures were evaluated using multivariable regression models adjusted for age, body mass index, treatment site, and baseline type 2 diabetes mellitus.
Results: A total of 1,899 patients met inclusion criteria (915 female patients and 984 male patients; mean age 72.5 years). At one year, the cumulative GC exposure and composite toxicity was not statistically different between sexes. At three years, cumulative GC exposure was higher in female patients (4,419.5 mg prednisone equivalents compared to 4,106.2 mg in male patients, P = 0.042) as well as daily GC dose (P = 0.037). Female patients had a higher incidence of fractures at three years (8.5% vs 3.2%, P ≤ 0.001) and incidence of giant cell arteritis (GCA; 7.6% vs 3.4%, P < 0.001).
Conclusion: The median cumulative GC exposure in patients with PMR remains high, with higher exposure in female patients. Female patients were more likely to experience fracture and the development of GCA within the same time frame.
Related
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- The 2026 British Society for Rheumatology guideline for the treatment of polymyalgia rheumatica
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- Imaging for diagnosis, monitoring and outcome prediction in polymyalgia rheumatica: a systematic literature review and meta-analysis informing an international task force
- 2025 EULAR recommendations for the management of polymyalgia rheumatica and primary large vessel vasculitis
BibTeX
@article{sullivan2026influence,
title = {{Influence of Sex on Glucocorticoid Toxicity Profiles in Polymyalgia Rheumatica}},
author = {Megan M. Sullivan and Simran Nimal and Dhara Awasthi and Joseph Rosen and Cynthia S Crowson and Eugene Bleecker and Deborah Meyers and Victor E. Ortega and Kenneth J. Warrington},
journal = {ACR Open Rheumatology},
year = {2026},
month = nov,
doi = {10.1002/acr2.90162},
url = {https://doi.org/10.1002/acr2.90162},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Influence of Sex on Glucocorticoid Toxicity Profiles in Polymyalgia Rheumatica
AU - Megan M. Sullivan
AU - Simran Nimal
AU - Dhara Awasthi
AU - Joseph Rosen
AU - Cynthia S Crowson
AU - Eugene Bleecker
AU - Deborah Meyers
AU - Victor E. Ortega
AU - Kenneth J. Warrington
PY - 2026
DA - 2026/11/04
JO - ACR Open Rheumatology
DO - 10.1002/acr2.90162
UR - https://doi.org/10.1002/acr2.90162
AB - Objective: Glucocorticoids (GCs) remain the primary treatment for polymyalgia rheumatica (PMR) but are associated with substantial long‐term toxicity. Although sex‐based differences in GC‐related adverse effects have been suggested, they have not been well studied in PMR. Methods: We conducted a retrospective cohort study of patients with PMR treated between 2017 and 2024 within a multisite health system. Patients ≥50 years of age with at least two PMR International Classification of Diseases, Tenth Revision, codes and documented GC dosing for ≥75% of days during the first six months of treatment were included. Sex‐based differences in GC toxicity outcomes including incident or worsening hypertension, type 2 diabetes mellitus, and incidence of fragility fractures were evaluated using multivariable regression models adjusted for age, body mass index, treatment site, and baseline type 2 diabetes mellitus. Results: A total of 1,899 patients met inclusion criteria (915 female patients and 984 male patients; mean age 72.5 years). At one year, the cumulative GC exposure and composite toxicity was not statistically different between sexes. At three years, cumulative GC exposure was higher in female patients (4,419.5 mg prednisone equivalents compared to 4,106.2 mg in male patients, P = 0.042) as well as daily GC dose (P = 0.037). Female patients had a higher incidence of fractures at three years (8.5% vs 3.2%, P ≤ 0.001) and incidence of giant cell arteritis (GCA; 7.6% vs 3.4%, P < 0.001). Conclusion: The median cumulative GC exposure in patients with PMR remains high, with higher exposure in female patients. Female patients were more likely to experience fracture and the development of GCA within the same time frame.
SN - 2578-5745
ER -