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Agnete Overgaard Donskov, Christoffer Søvsø Våben, Elisabeth Lindrup Nielsen, Andreas Wiggers Nielsen, Ellen Margrethe Hauge, Kresten Krarup Keller, Comment on: ‘Real-world outcomes of a dedicated fast-track polymyalgia rheumatica clinic’, Rheumatology, Volume 64, Issue 5, May 2025, Pages 3210–3211, https://doi.org/10.1093/rheumatology/keae633
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Dear Editor, We have read with great interest the recent publication by Cowley et al. in Rheumatology, ‘Real-world outcomes of a dedicated fast-track polymyalgia rheumatica clinic’. In a prospective study in Ireland, the authors assess the effectiveness of a fast track clinic (here named rapid access strategy) on establishing an early diagnosis of polymyalgia rheumatica (PMR) [1].
We agree with the authors that diagnosing PMR during ongoing treatment with glucocorticoids (GC) is challenging, since GC may mask the symptoms of both PMR and differential diagnoses. Currently, PMR is mainly managed by general practitioners (GP), and ∼50% of individuals with suspected PMR start GC before evaluation by a rheumatologist [2]. The main purpose of a rapid access strategy is to ensure a prompt and correct diagnosis before commencement of GC [3, 4].
Rapid access strategy
In the study by Cowley et al., 42.9% of patients with PMR had initiated prednisolone treatment within 4 weeks prior to rheumatological evaluation, which is a substantial improvement compared with previous reports from routine care in Ireland, where 80% of referred individuals suspected of PMR had commenced GC treatment [2]. However, the proportion is larger than the 11% reported in another study [4]. We noticed that GC-free referral was not a strict referral criterion in the study by Cowley et al. Recent recommendations, published after the commencement of this study, suggest deferring the commencement of GC until after specialist evaluation to enhance diagnostic accuracy for PMR [3].
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