Physical activity after planned cessation of prednisolone treatment in patients with polymyalgia rheumatica and/or giant cell arteritis: baseline data from the double edge-replace study

Jelena Stankovic; MarieLouise Lund; AnjaFenger Dreyer; Hajir Al-Jorani; Victor Brun Boesen; StinaWillemoes Borresen; LouiseLehmann Christensen; Ulla Feldt-Rasmussen; Dorte Glintborg; Simon Boggild Hansen; Richard Christian Jensen; NannaThurmann Jorgensen; LiseSofie Bislev; Randi Tei; Marianne Andersen; JensOtto Jorgensen

doi:10.1530/endoabs.99.P32

P32

Prev Next

Section Contents Cite

Endocrine Abstracts (2024) 99 P32 | DOI: 10.1530/endoabs.99.P32

ECE2024 Poster Presentations Adrenal and Cardiovascular Endocrinology (95 abstracts)

Physical activity after planned cessation of prednisolone treatment in patients with polymyalgia rheumatica and/or giant cell arteritis: baseline data from the double edge-replace study

Jelena Stankovic ^1,2 , MarieLouise Lund ^3,4 , AnjaFenger Dreyer ^5,6 , Hajir Al-Jorani ^5,6 , Victor Brun Boesen ^3,4 , StinaWillemoes Borresen ^3,4 , LouiseLehmann Christensen ^5,6 , Ulla Feldt-Rasmussen ^3,4 , Dorte Glintborg ^5,6 , Simon Bøggild Hansen ^1,2 , Richard Christian Jensen ⁵ , NannaThurmann Jørgensen ^3,4 , LiseSofie Bislev ¹ , Randi Tei ^1,2 , Marianne Andersen ^5,6 & JensOtto Jørgensen ^1,2

Views

Author affiliations

¹Aarhus Universitetshospital, Department of Internal Medicine and Endocrinology, Aarhus, Denmark; ²Aarhus University, Department of Clinical Medicine, Aarhus, Denmark; ³Rigshospitalet, Department of Endocrinology and Metabolism, København, Denmark; ⁴The University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, København, Denmark; ⁵Odense University Hospital, Department of Endocrinology, Odense, Denmark; ⁶University of Southern Denmark, Department of Clinical Research, Odense, Denmark

Introduction: Myopathy is a known and dreaded adverse effect of pharmacological glucocorticoid (GC) treatment, but its impact on daily physical activity is not known.

Aim: To measure spontaneous physical activity and musculoskeletal function in patients shortly after planned cessation of long-term (>12 weeks) prednisolone treatment.

Patients and methods: Baseline data from an ongoing nation-wide prospective study (DOUBLE EDGE – REPLACE) involving 49 patients [median (range) age 71 (51, 86) years, 29 females and 20 males] diagnosed with polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA) in GC free-remission for 2−12 weeks. Physical activity was assessed by ActiGraphy (wGT3X-BT, ActiGraph), a wearable wrist-device, capturing 7 consecutive days of activity data. Muscle function in terms of the short physical performance battery (SPPB) and time-up-and-go test (TUG) was also assessed. Finally, symptoms of GC-induced adrenal insufficiency (GIA) were assessed by a disease-specific questionnaire (AddiQoL-30 score), by which presence of GIA-symptoms were defined as a score of ≤85.

Results: Patients spent 57% (95%-CI: 55.0, 60.6) of the recorded time at sedentary activity (SA) levels and 10% (95%-CI: 8.1, 11.4) in moderate-vigorous physical activity (MVPA). The median (IQR) 6 month accumulated prednisolone-dose was 310 (208, 469) mg. Mean (S.D.) morning cortisol-level (nmol/l) was 246 (82) in patients with GIA-symptoms vs 315 (90) in the asymptomatic group (P<0.001). Patients who followed the WHO-recommendations of 60 min of MVPA daily performed better on the short physical performance battery (SPPB) (mean (S.D.) 10.3 (2.0) vs 8.4 (3.5)) and time-up-and-go (TUG) (mean (SD) 10.4 (6.4) vs 6.9 (1.7)), compared to those who did not meet the criteria (P=0.03 and P<0.01 respectively). The low-MVPA group was more comorbid measured by the Charlson comorbidity index (P=0.03). Multiple linear regression controlling for age and gender revealed no difference in SA or MVPA between patients with and without GIA-symptoms.

Conclusions: This is the first study to consecutively map spontaneous physical activity and muscle function in a population of PMR and GCA patients at risk of GC-induced myopathy. Only a small proportion of the patients met the WHO-recommendations of 60 min/day of MVPA. Low MVPA levels were associated with higher comorbidity, which illustrates broader health implications of inactivity. Higher GIA-symptoms did not correlate with objective activity measures. However, we hypothesize, that GC-related factors contribute to the so-called steroid-withdrawal syndrome. The ensuing prospective phase of the study will show if this is reversed by either time or low-dose hydrocortisone replacement.

EudraCT (2020-006121-65).

Funding: NNF20OC0063280