Spondyloarthritis & psoriatic arthritis
Late‐Onset Spondyloarthritis Presenting as Glucocorticoid‐Resistant Polymyalgia Rheumatica: A Hitherto Underappreciated Entity in Which Tumor Necrosis Factor or Interleukin ‐17 Blockade May Have a Therapeutic Role
Authors' conclusion
Late-onset SpA with PMR clinical presentations is characterized by failure to respond to or taper GC therapy and is often identified by SpA-specific osteitis patterns on MRI.
Study context
- Population
- Patients at Leeds Teaching Hospitals NHS Trust with psoriatic arthritis (PsA) or axSpA initially diagnosed as polymyalgia rheumatica (PMR) (2002–2024), fulfilling 2012 EULAR/ACR or Bird et al PMR criteria17 women and 14 men
- Participants
- 31 patients
- Outcome
- Clinical and imaging features of SpA initially diagnosed as PMR
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
- Median age, years (IQR 58-69)
- 62
- Spondyloarthritis (SpA) diagnosis within 3 months of presentation
- 12
- SpA diagnosis during remaining follow-up (median 3 [IQR 1-4] years)
- 19
- HLA-B27 positive, of 27 tested
- 4
- Bone marrow edema (BME) on magnetic resonance imaging (MRI) in spine and/or sacroiliac joints, of 25 imaged
- 20 (80%)
- BME in sacroiliac joint
- 17 (68%)
- BME in spine
- 15 (60%)
- Clinical resolution with C-reactive protein (CRP) normalization after initial glucocorticoid (GC), of 31
- 21
- Flares or CRP elevations among 21 initial responders
- 7
- Disease-modifying antirheumatic drugs (DMARDs) used, of 31
- 21
- csDMARDs
- 8
- Biologic agents (8 TNFi, 3 IL-17i)
- 11
- Treated with ≤10 mg/day GC
- 10
Observational data: associations, not effects.
Original publication
Late‐Onset Spondyloarthritis Presenting as Glucocorticoid‐Resistant Polymyalgia Rheumatica: A Hitherto Underappreciated Entity in Which Tumor Necrosis Factor or Interleukin ‐17 Blockade May Have a Therapeutic Role. Arthritis Rheumatol. Published 8 December 2025. doi:10.
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