Polymyalgia rheumatica and cancer risk: the importance of the diagnostic set

Ciro Manzo,1 Maria Natale2 1Department of Geriatric and Internal Medicine, 2Geriatric Rheumatologic Outpatient Clinic, Hospital “Mariano Lauro,” Sant’Agnello, Naples, Italy Abstract: In the last few years, the relationship between polymyalgia rheumatica (PMR) and cancer...

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Autores principales:	Manzo C, Natale M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	polymyalgia rheumatica cancer risk paraneoplastic phenomenon methodology. Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/faaae872fea44a4898d132d4a742e043
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spelling	oai:doaj.org-article:faaae872fea44a4898d132d4a742e0432021-12-02T01:29:29ZPolymyalgia rheumatica and cancer risk: the importance of the diagnostic set1179-156Xhttps://doaj.org/article/faaae872fea44a4898d132d4a742e0432016-10-01T00:00:00Zhttps://www.dovepress.com/polymyalgia-rheumatica-and-cancer-risk-the-importance-of-the-diagnosti-peer-reviewed-article-OARRRhttps://doaj.org/toc/1179-156XCiro Manzo,1 Maria Natale2 1Department of Geriatric and Internal Medicine, 2Geriatric Rheumatologic Outpatient Clinic, Hospital “Mariano Lauro,” Sant’Agnello, Naples, Italy Abstract: In the last few years, the relationship between polymyalgia rheumatica (PMR) and cancer has been considered with very different conclusions. In particular, in 2010, Ji et al examined the overall and specific cancer risks among Swedish subjects following hospitalization for PMR and giant cell arteritis and noted that the risk of cancer was highest in the first year after hospitalization (of 3941 total cancer diagnoses, 783 [19.1%] were in the first year). In 2013, Muller et al, using data from General Practice Research Database, highlighted that elderly patients with a PMR diagnosis were significantly more likely to receive a cancer diagnosis in the year after PMR diagnosis (313/667 cancer cases [69%]). In a series of 200 patients with PMR consecutively observed in our geriatric rheumatologic outpatient clinic from 2004 to 2014, we have observed 51 cancer cases; five of these were observed in the first year after diagnosis of PMR (percentage equal to 9.8%). In our article, we point out the importance of the diagnostic set. PMR is a disease that can be managed in a rheumatologic outpatient clinic without patients’ hospitalization. On the other hand, hospitalization of the elderly with PMR is useful when there are grounds for suspicion for a paraneoplastic syndrome, and this represents per se an important inclusion bias. The studies from institutional databases such as those of Ji et al and Muller et al have a very large series but diagnoses of the various diseases are based on coding and not always confirmed by individual medical record review. On the other hand, studies based on cohorts followed by single rheumatologic outpatient clinics can have much smaller data but have a higher diagnostic accuracy, because all patients are visited by rheumatologists and data are usually more accurate. The specificity of geriatric rheumatologic outpatient clinics with respect to elderly patients and to disease with an outpatient management (such as PMR) is often underestimated. In the health care organization of the geographic area that belongs to the hospital “Mariano Lauro”, the majority of patients for whom the general practitioner suspects a PMR are visited by a rheumatologist, as a consequence of an active collaboration between the general practitioner and the rheumatologist and thanks to the very short (5–7 days on average) waiting lists. In our cohort, diagnosis of PMR must be confirmed at least by a second rheumatologist. No change in the initial diagnosis was observed in any of our patients with PMR over the years and even after being examined by other colleagues from different centers. The repercussions of cancer risk in the elderly with PMR on health policies are easily understandable, and therefore the detection of all potential bias is mandatory. Data from other rheumatologic outpatient clinics are necessary. Keywords: polymyalgia rheumatica, cancer risk, paraneoplastic phenomenon, methodologyManzo CNatale MDove Medical Pressarticlepolymyalgia rheumaticacancer riskparaneoplastic phenomenonmethodology.Diseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol Volume 8, Pp 93-95 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	polymyalgia rheumatica cancer risk paraneoplastic phenomenon methodology. Diseases of the musculoskeletal system RC925-935
spellingShingle	polymyalgia rheumatica cancer risk paraneoplastic phenomenon methodology. Diseases of the musculoskeletal system RC925-935 Manzo C Natale M Polymyalgia rheumatica and cancer risk: the importance of the diagnostic set
description	Ciro Manzo,1 Maria Natale2 1Department of Geriatric and Internal Medicine, 2Geriatric Rheumatologic Outpatient Clinic, Hospital “Mariano Lauro,” Sant’Agnello, Naples, Italy Abstract: In the last few years, the relationship between polymyalgia rheumatica (PMR) and cancer has been considered with very different conclusions. In particular, in 2010, Ji et al examined the overall and specific cancer risks among Swedish subjects following hospitalization for PMR and giant cell arteritis and noted that the risk of cancer was highest in the first year after hospitalization (of 3941 total cancer diagnoses, 783 [19.1%] were in the first year). In 2013, Muller et al, using data from General Practice Research Database, highlighted that elderly patients with a PMR diagnosis were significantly more likely to receive a cancer diagnosis in the year after PMR diagnosis (313/667 cancer cases [69%]). In a series of 200 patients with PMR consecutively observed in our geriatric rheumatologic outpatient clinic from 2004 to 2014, we have observed 51 cancer cases; five of these were observed in the first year after diagnosis of PMR (percentage equal to 9.8%). In our article, we point out the importance of the diagnostic set. PMR is a disease that can be managed in a rheumatologic outpatient clinic without patients’ hospitalization. On the other hand, hospitalization of the elderly with PMR is useful when there are grounds for suspicion for a paraneoplastic syndrome, and this represents per se an important inclusion bias. The studies from institutional databases such as those of Ji et al and Muller et al have a very large series but diagnoses of the various diseases are based on coding and not always confirmed by individual medical record review. On the other hand, studies based on cohorts followed by single rheumatologic outpatient clinics can have much smaller data but have a higher diagnostic accuracy, because all patients are visited by rheumatologists and data are usually more accurate. The specificity of geriatric rheumatologic outpatient clinics with respect to elderly patients and to disease with an outpatient management (such as PMR) is often underestimated. In the health care organization of the geographic area that belongs to the hospital “Mariano Lauro”, the majority of patients for whom the general practitioner suspects a PMR are visited by a rheumatologist, as a consequence of an active collaboration between the general practitioner and the rheumatologist and thanks to the very short (5–7 days on average) waiting lists. In our cohort, diagnosis of PMR must be confirmed at least by a second rheumatologist. No change in the initial diagnosis was observed in any of our patients with PMR over the years and even after being examined by other colleagues from different centers. The repercussions of cancer risk in the elderly with PMR on health policies are easily understandable, and therefore the detection of all potential bias is mandatory. Data from other rheumatologic outpatient clinics are necessary. Keywords: polymyalgia rheumatica, cancer risk, paraneoplastic phenomenon, methodology
format	article
author	Manzo C Natale M
author_facet	Manzo C Natale M
author_sort	Manzo C
title	Polymyalgia rheumatica and cancer risk: the importance of the diagnostic set
title_short	Polymyalgia rheumatica and cancer risk: the importance of the diagnostic set
title_full	Polymyalgia rheumatica and cancer risk: the importance of the diagnostic set
title_fullStr	Polymyalgia rheumatica and cancer risk: the importance of the diagnostic set
title_full_unstemmed	Polymyalgia rheumatica and cancer risk: the importance of the diagnostic set
title_sort	polymyalgia rheumatica and cancer risk: the importance of the diagnostic set
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/faaae872fea44a4898d132d4a742e043
work_keys_str_mv	AT manzoc polymyalgiarheumaticaandcancerrisktheimportanceofthediagnosticset AT natalem polymyalgiarheumaticaandcancerrisktheimportanceofthediagnosticset
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Polymyalgia rheumatica and cancer risk: the importance of the diagnostic set

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