Achievement and maintenance of glycemic control in older patients with type 2 diabetes and polymyalgia rheumatica were associated with rapid improvements in symptoms and laboratory measures of polymyalgia rheumatica without glucocorticoids or increases in current glucocorticoid therapy, according to findings from a case series published in the Annals of Internal Medicine.
The case series featured a report of a 68-year-old man with type 2 diabetes who fulfilled the 6 provisional criteria for polymyalgia rheumatica established by the 2012 European League Against Rheumatism/American College of Rheumatology. The patient was using nonsteroidal anti-inflammatory drugs (NSAIDs) without any effect, as well as metformin and a dipeptidyl peptidase-4 inhibitor to control hyperglycemia.
Despite treatment, the patient’s glucose level remained elevated, but the addition of repaglinide and modifications to his antidiabetic regimen resulted in glycemic improvements. Approximately 1 week after changing the antidiabetic medication regimen, symptoms and laboratory measures of the polymyalgia rheumatica improved considerably. In addition, biceps tenosynovitis disappeared gradually over 1 year.
In another case report, a 72-year-old woman’s polymyalgia rheumatica symptoms also improved with greater glycemic control. These symptoms and laboratory findings improved during a 2-week period after the introduction of repaglinide, which was later switched to mitiglinide, for the reduction of the patient’s glucose levels.
A 73-year-old man who had been using NSAIDs for 5 months with no effect or benefit also achieved improvements in polymyalgia rheumatica symptoms and laboratory findings after 2 weeks of initiating mitiglinide and pioglitazone to achieve glycemic control.
The primary limitation of this cases series was the small number of patients; this may limit generalizability across the larger population of patients with polymyalgia rheumatica and concurrent type 2 diabetes mellitus.
Based on this case series, the researchers proposed that a randomized controlled trial be conducted “to determine whether improved glycemic control, perhaps with a meglitinide, might allow patients with type 2 diabetes mellitus and polymyalgia rheumatica to avoid glucocorticoid treatment.”
Yoshida K, Sakamoto N, Kurosaka D. Improvement in polymyalgia rheumatica associated with improved control of diabetes mellitus: a case series. Published online September 15, 2020. Ann Intern Med. doi: 10.7326/L20-0196