ABSTRACT
INTRODUCTION: GCA (giant cell arteritis) and PMR (polymyalgia rheumatica) are two overlapping inflammatory rheumatic conditions that are seen exclusively in older adults, sharing some common features. GCA is a clinical syndrome characterized by inflammation of the medium and large arteries, with both cranial and extracranial symptoms. PMR is a clinical syndrome characterized by stiffness in the neck, shoulder, and pelvic girdle muscles. Both are associated with constitutional symptoms. AREAS COVERED: In this review, we assess the established and upcoming treatments for GCA and PMR. We review the current treatment landscape, completed trials, and upcoming trials in these conditions, to identify new and promising therapies. EXPERT OPINION: Early use of glucocorticoids (GC) remains integral to the immediate management of PMR and GCA but being aware of patient co-morbidities that may influence treatment toxicity is paramount. As such GC sparing agents are required in the treatment of PMR. Currently there are limited treatment options available for PMR and GCA, and significant unmet needs remain. Newer mechanisms of action, and hence therapeutic options being studied include CD4 T cell co-stimulation blockade, IL-17 inhibition, IL-12/23 inhibition, GM-CSF inhibition, IL-1ß inhibition, TNF-α antagonist and Jak inhibition, among others, which will be discussed in this review.
Subject(s)
Giant Cell Arteritis , Polymyalgia Rheumatica , Humans , Aged , Giant Cell Arteritis/drug therapy , Giant Cell Arteritis/complications , Giant Cell Arteritis/diagnosis , Polymyalgia Rheumatica/drug therapy , Polymyalgia Rheumatica/complications , Polymyalgia Rheumatica/diagnosis , Glucocorticoids/pharmacology , Glucocorticoids/therapeutic use , Inflammation/drug therapy , Clinical Trials, Phase III as TopicABSTRACT
International medical graduates (IMGs) face countless challenges when migrating to a new healthcare system, of which understanding the UK appraisal and revalidation system is one. We investigated whether provision of educational material on appraisals would improve IMGs' confidence in their understanding of the UK appraisal system. A prospective pre-post interventional study aimed at IMGs was carried out between 25 February 2022 and 9 March 2022. A mixed-methods survey was undertaken pre (n=519) and post (n=63) intervention. The pre-interventional survey highlighted IMGs' lack of experience and knowledge of the General Medical Council (GMC) appraisal and revalidation process. Postinterventional responses showed a significantly higher confidence rating in IMGs' understanding of the UK appraisal process (p<0.001). Utilising simple educational tools can be beneficial for IMGs to gain confidence in navigating appraisals and help bridge the attainment gap when entering a new healthcare system. Barriers, such as lack of knowledge, can be easily rectified without the need for significant investment.
