Guideline-concordant care and sex differences in incident polymyalgia rheumatica in Germany: a retrospective claims data cohort study (2011–2020)

Objective Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease in older adults, with a higher prevalence in women than in men. In Germany, real-world data on the clinical management of patients with PMR remain limited, particularly regarding diagnostic pathways, treatment patterns, and adherence to guideline recommendations. In addition, sex-specific differences in care processes have not been systematically examined. Against this background, the objective of this study was to assess guideline-concordant care for patients with incident PMR in Germany and to evaluate potential sex-specific differences in diagnostic and therapeutic management. Design In this retrospective cohort study, claims data from individuals aged ≥50 years with incident polymyalgia rheumatica (2011–2020) were analyzed using data from a German regional health insurance fund. Medical care was assessed by operationalizing recommendations from the 2017 German PMR guideline. Descriptive analyses were performed, and effect sizes were estimated using Cohen’s d, Phi coefficients, and Cramér’s V. Results A total of 22,751 patients were included; 66.2% were female, and mean age was 72.0 years. During the first year after incident PMR, 99.8% of patients were managed by general practitioners alone (16.2%) or in collaboration with at least one specialist (83.6%). Glucocorticoid therapy was initiated in 91.3% of patients. Although median initial doses were within the recommended range, 22.7% received lower and 30.6% higher doses. Physiotherapy was prescribed in 33.8% of patients. Sex differences were observed across recommendations but showed only minimal or negligible clinical relevance. Discussion Care in patients with incident PMR was largely consistent with guideline recommendations. However, a substantial proportion of patients received initial glucocorticoid doses outside the recommended range, indicating variability in prescribing practice. Due to the limitations of claims data, particularly the lack of clinical and laboratory parameters, future studies should integrate primary clinical data to better contextualize diagnostic and therapeutic decisions as well as sex differences.