Comparative biochemical parameters in deceased and living patients in a follow-up intervention study of cardiovascular patients

After the laboratory-diagnostical spectrum had been analysed by means of a representative check of probationer with a state suspected of heart and vessel diseases on the screen of the X-ray mass examination in longitudinal section and cross-section with derived conclusions the results had been checked by means of comparison with the dead and not dead of this population in the follow up. The parameter sedimentation rate of erythrocyte, blood sugar, the enzymes "ASAT" and "ALAT" and total cholesterol with stronger pronounced proneness could substantiate the causal connection to this population of persons suffering from a heart disease as well. Hence followed derived relations to the severe degree of heart and vessel disease and beside this to the prognostical estimation of the disease for the parameter uric acid, hemoglobin/hematocrit and creatinine in the serum. The number of leucocytes, the serum protein, the separation of fractions of serum protein and lability test of serum by electrophoresis did not result in any findings, which allowed any connection with heart and vessel diseases, also concerning the persons who died in the course of the study, so that the demand for a differentiated, well-aimed differential-diagnostical use of these expensive research methods also for this extreme situation is substantiated once more. The results are discussed in comparison as well as in connection with the results found out of the total check and in dependence of age and sexes.     

Redundancy reduction in laboratory studies--evaluated by the laboratory diagnostic follow-up program of an epidemiologic cardiovascular study

In addition to our information about significant relations of certain laboratory parameters concerning probationers suspected of heart and vessel diseases, who were identified by means of x-ray screening (EBMO-Cor Berlin) is reported on laboratory parameters applied to follow-up examinations, which proved to be redundant for what was expected (referring the heart and vessel diseases). It refers to the parameters of total protein in the serum, serum electrophoresis, zinc-sulphate test, hematocrit and hemoglobin. The results are supported by mathematic--statistical returns. With regard to the exponential laboratory load in the result of screening and follow-up examination under suspicion of heart and vessel disease the necessity of such considerations is underlined. The statement gains in its significance by the original material concerning the population.     

Correlation of pathologic laboratory values in patients with cardiovascular diseases--consequences for diagnosis in general practice

Coincident pathological parameters were selected from 24 laboratory-diagnostic parameters of a second stage of diagnostics after x-rays screening concerning heart and vessel diseases tested by a check representative constellation in the shape of relative frequency was determined. For the parameters cholesterol, uric acid and glucose, belonging to the metabolic syndrome, it was possible to demonstrate relations to the erythrocyte sedimentation rate. The transaminases ASAT and ALAT especially showed correlations of pathological values among one another. There were found out one-sided relations for instance concerning the proportion of transaminases, thymol turbidity test as well as creatinine to the erythrocyte sedimentation rate. The connections as has been proved appeared in female cardiac patients in a more distinct way. The results, which were interpreted in the context of a further mathematic-statistical analysis, allow the conclusions for an efficient indicational application of clinical chemical research methods in chronic heart and vessel diseases in practice.     

Behavior of so-called cardiovascular risk factors in general practice cardiac therapy--results of selected biochemical parameters of probands with suspect cardiovascular findings in a follow-up program of a 5-year intervention study

Based on a population of defined territories of 280,000 inhabitants, heart patients, morphologically defined by roentgenological findings, were detected, and a representative sample was controlled with differing intervention under conditions of practice in a follow-up-programme of five years. Out of this programme the developments of some so-called (biochemical) risk factors belonging to the metabolical syndrome were evaluated and interpreted in their relation to cardiovascular diseases. The parameters investigated such as lipoprotein flocculation reaction, serum cholesterol, blood glucose and uric acid revealed increases of mean values as well as differences between the sexes and certain age groups during the time of observation. Causal therapeutic measures are discussed as causes of these developments. Significant differences in the cross section analysis which were also established could be confirmed in a longitudinal observation, and their relevance to cardiovascular diseases could thus be verified.     

Reference values for blood findings in relatively fit elderly persons

In a retirement community group of 73 relatively fit elderly white persons, a cross-sectional study of 53 different blood tests was conducted. The five test categories for blood values were hematology, chemistry, thyroid function, protein electrophoresis, and immunology. Fifteen percent of the blood findings were outside the range accepted as normal by the examining laboratories. Most of the subjects showed between 5 and 10 "abnormal" values within the five test categories. Since the findings were fairly predictable in view of the patho-anatomic changes that accompany aging, and since the manifestations of disease were at most subclinical, only minor alterations in individual management were needed. Subsequent appropriate clinical re-evaluation of these subjects during a six-month follow-up revealed no striking changes. It would appear that the ranges of "normal" reference values may need to be expanded. Although cross-sectional laboratory studies are useful, longitudinal studies seem essential if clinicians are to attain a more valid perspective.     

The importance of symptoms in the longitudinal variability of clusters in COPD patients: A validation study

Background and objective

Cluster analysis has been utilized to explore phenotypic heterogeneity in chronic obstructive pulmonary disease (COPD). To date, little is known about the longitudinal variability of clusters in COPD patients. We aimed to evaluate the 2‐year cluster variability in stable COPD patients.

Methods

We evaluated the following variables in COPD patients at baseline and 2 years later: age, gender, pack‐year history, body mass index (BMI), modified Medical Research Council (MMRC) scale, 6‐min walking distance (6MWD), spirometry and COPD Assessment Test (CAT). Patient classification was performed using cluster analysis at baseline and 2 years later. Each patient’s cluster variability after 2 years and its parameters associated with cluster change were explored.

Results

A total of 521 smokers with COPD were evaluated at baseline and 2 years later. Three different clusters were consistently identified at both evaluation times: cluster A (of younger age, mild airway limitation, few symptoms), cluster B (intermediate) and cluster C (of older age, severe airway limitation and highly symptomatic). Two years later, 70% of patients were unchanged, whereas 30% changed from one cluster to another: 20% from A to B; 15% from B to A; 15% from B to C; 42% from C to B and 8% from C to A. 6MWD, forced expiratory volume in 1 s (FEV₁) % and CAT were the principal parameters responsible for this change.

Conclusion

After 2 years of follow‐up, most of the COPD patients maintained their cluster assignment. Exercise tolerance, lung function and quality of life were the main driving parameters in those who change their cluster assignment.

     

Study on the hemorheological parameters of oldest-old residents in the East-Hungarian city, Debrecen

The aim of this study was to assess social and health status of residents older than 90 years in an East-Hungarian city. The investigation involved 70 subjects, measuring routine laboratory parameters and plasma viscosity. Mean cholesterol, erythrocyte sedimentation rate (ESR), collagen cross links and plasma viscosity values exceeded the reference range, but mean red blood cell count, hematocrit and hemoglobin were below it. Plasma viscosity was found pathologically elevated in 51% of cases. We compared these results with an earlier laboratory screening test performed on the same population with the age range of 60 to 90 years. In this cohort the mean fibrinogen concentration, ESR, HDL-cholesterol and collagen cross links values were higher, but mean cholesterol, triglyceride, total protein, hemoglobin and hematocrit values were lower than the reference range.     

Thermal Analysis-Based Field Validation of the Deformation of a Recycled Base Course Made with Innovative Road Binder

The deformation of the cold recycled mixture with foamed bitumen in a recycled base with an innovative three-component road binder and foamed bitumen is analysed. Numerical simulation results for the pavement constructed, based on laboratory test results, were verified against the data from the monitoring system installed on the road trial section. In addition, environmental effects, such as air temperature and humidity levels in the pavement structure layers, were considered. Thermal analyses were conducted to identify the thermal properties of the pavement materials under steady heat transfer rate. Determining temperature distribution in the road cross-section in combination with relaxation functions determined for individual pavement layers contributed to the high effectiveness of the numerical simulation of deformation and displacement in the recycled base and the entire pavement. The experimental method of identifying thermal properties allows a fast and satisfactory prediction of temperature distribution in the pavement cross-section.     

Safety and efficacy profiles of tocilizumab monotherapy in Japanese patients with rheumatoid arthritis: meta-analysis of six initial trials and five long-term extensions

We present safety and efficacy data from Japanese clinical studies on monotherapy with tocilizumab (TCZ), a humanized anti-interleukin 6 receptor monoclonal antibody, in which 601 patients with moderate to severe rheumatoid arthritis, with a total of 2188 patient-years (pt-yr) exposure, were enrolled. The median treatment duration was 3.8 years. The incidence of adverse events (AEs), including abnormal laboratory test results, was calculated as 465.1 per 100 pt-yr. The most common serious adverse events (SAEs) were infections (6.22 per 100 pt-yr). There was no increase in the frequency of AEs or SAEs with long-term treatment. Abnormalities in the laboratory test results, such as increases in lipid parameters or abnormal liver function parameters, were common, but most were mild and there were no SAEs related to them. At baseline, 546 patients (90.8%) were taking corticosteroids; of these, 77.8% were able to decrease their corticosteroid dose during the study period, while 35.2% discontinued corticosteroids altogether. In the patients treated longer than 5 years, 91.3, 73.0, and 51.3% met the ACR20, ACR50, and ACR70 response criteria, respectively, and 59.7% met the DAS remission criterion (DAS28 <2.6) at 5 years. In conclusion, based on these results, TCZ has shown good tolerability and high efficacy during long-term treatment.     

Increased mortality in adults with a history of juvenile rheumatoid arthritis: A population‐based study

Objective

To assess mortality in a population‐based cohort of adults with a history of juvenile rheumatoid arthritis (JRA).

Methods

The Rochester Epidemiology Project database was used to identify all cases of JRA diagnosed among Rochester, Minnesota residents under the age of 16 between January 1, 1960 and December 31, 1993. Fifty‐seven patients in this cohort are now adults (ages 18–53 years, mean age 34.3 years), and this subgroup was contacted for a long‐term followup study. The average length of followup from the time of diagnosis was 25.6 years.

Results

Four deaths occurred in this cohort of 57 adults with a history of JRA. All 4 deceased patients had other autoimmune illnesses and died of complications of these diseases. The observed frequency of 4 deaths was significantly greater (P < 0.0026 by one‐sample log‐rank test) than the 1 death that would be expected among Minnesota whites of similar age and sex, and corresponds to a mortality rate of 0.27 deaths per 100 years of patient followup compared with an expected mortality rate of 0.068 deaths per 100 years of followup in the general population.

Conclusion

The results indicate a significant, unexpected increase in mortality in this population‐based cohort of adults with a history of JRA in comparison with the rate in the general population. The deaths in this group were all associated with other autoimmune disorders, suggesting that special emphasis should be given to the diagnosis and treatment of other autoimmune diseases, including immunodeficiencies, in JRA patients. The frequency of deaths in this cohort suggests that JRA patients are at substantial risk for mortality, and highlights the need for longitudinal followup and care into adulthood.

     

Comment on the use of self‐reporting instruments to assess patients with rheumatoid arthritis: The longitudinal association between the DAS28 and the VAS general health

Objective

Recently, the use of patient self‐reporting instruments instead of clinical, objective measurements to assess rheumatoid arthritis (RA) patients was proposed. This assumes a constant association between disease activity and the self‐reporting instruments. The objective was to explore the association (in time) between disease activity and patient perception of general health, disease activity, pain, and functional disability in patients with RA.

Methods

Data of 624 newly diagnosed RA patients who completed 3 years of followup were analyzed. Cross‐sectional linear regression models and longitudinal regression models were estimated, with a visual analog scale (VAS) measuring general health (VAS‐GH; 0 = best, 100 = worst) as a dependent variable and the Disease Activity Score (DAS28) without the VAS‐GH as an independent variable. Other dependent variables were VAS disease activity, pain, and the Health Assessment Questionnaire.

Results

The DAS28 and VAS‐GH were significantly associated in RA patients (P < 0.001). However, the explained variance was low (6.7%). From diagnosis to 3 years after the diagnosis, the intercept decreased given the same regression coefficient. The longitudinal regression model showed that the VAS‐GH improved during disease course independent of a change in DAS28. Analyses on the other outcome parameters showed similar results.

Conclusion

Patients' perception of health can be different with equal disease activity, depending on the moment in the disease course. Furthermore, our results indicate that self‐reported measures on functionality, disease activity, and general health cannot substitute for objective measures of disease activity in RA in longitudinal studies; subsequently, both need to be measured.

     

High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors

Objective

To compare the incidence of cardiovascular (CV) events in persons with rheumatoid arthritis (RA) with that in people from the general population, adjusting for traditional CV risk factors.

Methods

Two hundred thirty‐six consecutive patients with RA were assessed for the 1‐year occurrence of 1) CV‐related hospitalizations, including myocardial infarction, stroke or other arterial occlusive events, or arterial revascularization procedures, or 2) CV deaths. Both outcomes were ascertained by medical records or death certificates. For comparison, we used CV events that occurred during an 8‐year period among participants in an epidemiologic study of atherosclerosis and CV disease who were ages 25–65 years at study entry. We calculated the age‐ and sex‐stratified incidence rate ratio (IRR) of CV events between the 2 cohorts and used Poisson regression to adjust for age, sex, smoking status, diabetes mellitus, hypercholesterolemia, systolic blood pressure, and body mass index.

Results

Of the 236 RA patients, 234 were observed for 252 patient‐years, during which 15 CV events occurred. Of these, 7 incident events occurred during the 204 patient‐years contributed by patients ages 25–65 years, for an incidence of 3.43 per 100 patient‐years. In the comparison cohort, 4,635 community‐dwelling persons were followed up for 33,881 person‐years, during which 200 new events occurred, for an incidence of 0.59 per 100 person‐years. The age‐ and sex‐adjusted IRR of incident CV events associated with RA was 3.96 (95% confidence interval [95% CI] 1.86–8.43). After adjusting for CV risk factors using Poisson regression, the IRR decreased slightly, to 3.17 (95% CI 1.33–6.36).

Conclusion

The increased incidence of CV events in RA patients is independent of traditional CV risk factors. This suggests that additional mechanisms are responsible for CV disease in RA. Physicians who provide care to individuals with RA should be aware of their increased risk of CV events and implement appropriate diagnostic and therapeutic measures.

     

Responsiveness of exercise parameters in children with inflammatory myositis

OBJECTIVE: Juvenile dermatomyositis (DM) is an inflammatory myopathy in which the immune system targets the microvasculature of the skeletal muscle and skin, leading to significant muscle weakness and exercise intolerance, although the precise etiology is unknown. The goal of this study was to investigate the changes in exercise capacity in children with myositis during active and inactive disease periods and to study the responsiveness of exercise parameters. METHODS: Thirteen children with juvenile DM (mean+/-SD age 11.2+/-2.6 years) participated in this study. Patients performed a maximal exercise test using an electronically braked cycle ergometer and respiratory gas analysis system. Exercise parameters were analyzed, including peak oxygen uptake (VO2peak), peak work rate (Wpeak), and ventilatory anaerobic threshold (VAT). All children were tested during an active period of the disease and during a remission period. From these data, 4 different response statistics were calculated. RESULTS: The children performed significantly better during a remission period compared with a period of active disease. Most exercise parameters showed a very large response. The 5 most responsive parameters were Wpeak, Wpeak (percent predicted), oxygen pulse, VO2peak, and power at the VAT. CONCLUSION: We found in our longitudinal study that children with active juvenile DM had significantly reduced exercise parameters compared with a remission period. Moreover, we found that several parameters had very good responsiveness. With previously established validity and reliability, exercise testing has been demonstrated to be an excellent noninvasive instrument for the longitudinal followup of children with myositis.     

Prevalence of thyroid disease and abnormal thyroid function test results in patients with systemic lupus erythematosus

Although thyroid disease has been associated with other autoimmune conditions, it is not well recognized in systemic lupus erythematosus (SLE) patients. We found that in 332 SLE patients hospitalized during a 5-year period, the overall prevalence of diagnosed thyroid disease (7.5%) was similar to that in other female populations, but the prevalence of diagnosed hypothyroidism (6.6%) was unexpectedly high. There was also a high frequency of abnormal thyroid function test results in 175 SLE patients without diagnosed thyroid disease who underwent laboratory screening. More than 45% of these patients had elevated levels of thyroid-stimulating hormone, 34% had low T3 determinations, and 18% had high antimicrosomal antibody titers. When patients were categorized into "functional groups," some showed evidence of the "euthyroid sick syndrome" (15%), but many more had laboratory test results suggestive of true (5%) or incipient (39%) primary hypothyroidism. We conclude that abnormal thyroid function test results are common in patients with SLE and that hypothyroidism, especially, should be considered when evaluating symptoms and signs in SLE patients.     

Clustering of biological risk factors for cardiovascular disease and the longitudinal relationship with lifestyle of an adolescent population: the Northern Ireland Young Hearts Project

OBJECTIVE: To determine whether clustering of biological cardiovascular disease (CVD) risk factors exists and to investigate the longitudinal relationship between lifestyle parameters (dietary intake, physical activity and smoking behaviour) and clustering of biological CVD risk factors, which was defined as belonging to one or more sex-specific 'high-risk' quartiles for the ratio between levels of total serum cholesterol and high-density lipoprotein cholesterol, diastolic blood pressure, body fatness (sum of four skinfolds) and cardiopulmonary fitness (number of laps accomplished on a 20 m shuttle-run test). METHODS: The study was part of the Northern Ireland Young Hearts Project, a 3-year observational longitudinal study concerning adolescent boys (n=229) and girls (n=230) who were initially aged 12 years. The longitudinal relationships were analysed with generalized estimating equations. RESULTS: Significant clustering of biological CVD risk factors was observed both for boys and for girls, but the stability over time was rather low. Smoking was the only lifestyle parameter related to this clustering and was observed only among girls (rate ratio 1.5, P < 0.01); furthermore, none of the lifestyle parameters was significantly related to this clustering. CONCLUSIONS: Because biological CVD risk factors tend to cluster, it is important to investigate these risk factors together. However, for subjects in this age group, according to our analysis, lifestyle parameters were hardly related to this clustering.     

Interleukin‐6 is a significant predictor of radiographic knee osteoarthritis: The Chingford study

Objective

There is a great need for identification of biomarkers that could improve the prediction of early osteoarthritis (OA). We undertook this study to determine whether circulating levels of interleukin‐6 (IL‐6), tumor necrosis factor α (TNFα), and C‐reactive protein (CRP) can serve as useful markers of radiographic knee OA (RKOA) in a normal human population.

Methods

RKOA data were obtained from the cohort of the Chingford Study, a prospective population‐based study of healthy, middle‐aged British women. The RKOA‐affected status of the subjects was assessed using the Kellgren/Lawrence (K/L) grade as determined on radiographs obtained at baseline (n = 908) and at 10 years and 15 years thereafter. Serum levels of CRP, IL‐6, and TNFα were assayed at 5, 8, and 15 years, using high‐sensitivity commercial assays. A K/L grade of ≥2 in either knee was used as the outcome measure. Statistical analyses included analysis of variance for repeated measurements and logistic regression models, together with longitudinal modeling of dichotomous responses.

Results

During 15 years of followup, the prevalence of RKOA (K/L grade ≥2) increased from 14.7% to 48.7% (P < 0.00001 versus baseline). The body mass index (BMI) and circulating levels of CRP and IL‐6 were consistently and significantly higher in subjects diagnosed as having RKOA. When multiple logistic regression was applied to the data, the variables of older age (P = 3.93 × 10⁻⁵), higher BMI at baseline (P = 0.0003), and increased levels of IL‐6 at year 5 (P = 0.0129) were determined to be independent predictors of the appearance of RKOA at year 10. The results were fully confirmed using longitudinal modeling of repeated measurements of the data obtained at 3 visits. The odds ratio for RKOA in subjects whose IL‐6 levels were in the fourth quartile of increasing levels (versus the first quartile) was 2.74 (95% confidence interval 1.94–3.87).

Conclusion

This followup study showed that individuals were more likely to be diagnosed as having RKOA if they had a higher BMI and increased circulating levels of IL‐6. These results should stimulate more work on IL‐6 as a potential therapeutic target.

     

Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults

Although increased blood viscosity occurs in several cardiovascular diseases, little is known of factors influencing blood rheology in normal adults. Accordingly, we examined the relations of whole blood viscosity (WBV) to its rheologic determinants (hematocrit level, plasma viscosity, protein concentration, and red cell aggregability and rigidity), to demographic and laboratory variables, and to cardiovascular risk factors in 128 normotensive employed adults. Hematocrit levels accounted for 67-84% of variability of WBV at shear rates from 208 to 0.1 sec-1 with lesser contributions from plasma viscosity, red cell aggregability, and rigidity (multiple r = 0.95-0.97); WBV was predicted accurately from standard measurements of hematocrit and total plasma protein levels (multiple r = 0.78-0.92 in "learning" and "test" analysis). Male sex, obesity, dietary Na+ intake, and increasing age had additive effects on WBV (multiple r greater than or equal to 0.59, p less than 0.00001); the last three of these factors and black race independently predicted plasma viscosity (multiple r = 0.36, p less than 0.001). Among regulators of plasma volume, plasma renin activity and urinary Na+ excretion bore independent positive relations to WBV. Diastolic and mean blood pressures were independent predictors of WBV and hematocrit levels (all p less than 0.05). Conventional risk factors (e.g., triglycerides, obesity, and cholesterol levels) were positively related to WBV or plasma viscosity. Thus, in apparently normal adults, 1) WBV or plasma viscosity are increased by male sex, obesity, high sodium intake, aging, and black race, 2) WBV is positively related to plasma renin activity, 3) WBV or plasma viscosity are related to diastolic and mean blood pressures, triglycerides and cholesterol concentrations, and 4) WBV can be predicted from simple measurements of hematocrit and total plasma protein levels.     

Relation between obesity and atherogenic risk factors in a longitudinal study

Since 1980 clinical, biochemical and anthropometric examinations have been performed annually on 46 adipose patients (25 males, 18 females) and 53 test persons (35 males, 18 females) at the age of 25 to 40 years. Several of the established parameters (e. g. cholesterol, triglycerides, uric acid, blood pressure among others) in the course of the 5 years within the known normal regions drew towards the adequate limiting value to the pathological. The results of the study clearly show the central role of the overweight for the formation of risk factors. Despite the partly only in a certain tendency recognizable behaviour of individual signs after 5 years from our point of view the longitudinal technique represents itself as a very well suitable method to realize dynamic processes and risk factors of ageing.     

The diagnostic value of the aminophenazone breath test in chronic liver diseases

In 230 patients (90 females, 140 males aged between 20 and 73 years, average age 47.8 years) with and without exception histologically and/or laparoscopically ascertained chronic liver diseases (degenerative damages of liver parenchyma in 45, fatty liver stage I in 28, fatty liver stage II in 36, cholangiohepatitis in 4, chronic persisting hepatitis in 31, chronic active hepatitis in 57 and liver cirrhosis in 59 cases) the incorporation of the aminophenazon breathing test in the so-called laboratory chemical liver spectrum was controlled. The restriction of the microsomal biotransformation established by means of the aminophenazon breathing test behaved parallel to the degree of severity of the disease. The aminophenazon breathing test was performed in the modification after Haustein and Schenker (1985). The largest delays in the decomposition were found in the complete cirrhotic transformation of the liver. The unequivocally pathologic result of the aminophenazon breathing test in severe irreversible damages of the liver parenchyma was confirmed by the formation of correlations with parameters of the conventional laboratory spectrum of the liver. Thus the restriction of the performance of the synthesis of the liver for coagulation factors and albumins was parallel to the loss of function of the mixed functional oxidases. In all patients with chronic liver diseases a connection between the value of the thromboplastin time (Quick's test) and result of the breathing test was found. Positive linear correlation between serum albumin and results of the breathing test could also be proved particularly in the group of the severe chronic inflammatory liver diseases. In chronic fibrosing liver diseases there were positive inverse correlations between gamma-globulin concentration in the serum and thymol turbidity test on the one hand as well as the aminophenazon breathing test on the other. There were no correlations between liver enzyme and aminophenazon breathing test. The results of the own investigations incorporate the aminophenazon breathing test as indicator of a severe liver cell damage which at the same time is established by the pathological result of the so-called synthesis parameters of the liver.     

Acute‐phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: A prospective followup study

Objective

To determine laboratory parameters that may be useful in identifying polymyalgia rheumatica (PMR) patients who require long‐term corticosteroid therapy.

Methods

A prospective followup study of 94 consecutive untreated patients with PMR were assessed for relapse/recurrence for a mean of 39 months. This cohort represented all the patients diagnosed over a 4‐year period in 2 Italian secondary referral centers. Patients were monitored for clinical signs and symptoms, erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), and serum interleukin‐6 (IL‐6). IL‐6 levels were also measured in 43 controls matched to the patients for age and sex.

Results

The ESR was elevated in 91.5% of the patients prior to therapy initiation, as were CRP in 98.9% and serum IL‐6 in 92.6%. Forty‐seven (50.0%) patients had at least 1 relapse/recurrence during the followup period and 24 (25.5%) had at least 2. After 4 weeks of prednisone therapy, ESR was elevated in 13.2% patients, CRP in 41.9%, and serum IL‐6 in 37.2%. IL‐6 levels remained persistently elevated in 9.9% and CRP in 8.7% of patients during the first year of followup, whereas no patient had persistently elevated ESR. Persistently elevated CRP and IL‐6 levels were significantly associated with an increased risk of relapse/recurrence. In particular, patients with persistently elevated levels of IL‐6 during the first year of therapy had the highest relative risk.

Conclusion

Despite the control of clinical symptoms, corticosteroids do not adequately control the inflammatory process in a subset of patients with PMR who have persistently elevated levels of CRP and IL‐6 and who have a higher risk of relapsing.