Are you applying to universities? | SHARE YOUR EXPERIENCE Are you applying to universities? | SHARE YOUR EXPERIENCE

Simulation modelling of pathways of management for polymyalgia rheumatica

   Norwich Medical School

This project is no longer listed on and may not be available.

Click here to search for PhD studentship opportunities
  Prof A MacGregor  No more applications being accepted  Competition Funded PhD Project (UK Students Only)

About the Project

Polymyalgia rheumatica (PMR) is the commonest inflammatory musculoskeletal condition affecting 1.7% of those aged older than 55yrs and is treated with glucocorticoids. National guidelines endorsed by NICE recommend that patients take glucocorticoids for 1 to 2 years and that those who require longer treatment be referred to rheumatologists for specialist input. Meta-analyses from observational studies and routinely collected primary care data show that around half of patients take glucocorticoids longer than this.  

However, the reasons why and the patterns of prescribing for patients are not clear. In addition, it is hypothesed that there are sub-groups of patients with PMR whose glucocorticoid requirements differ. Analyses of patients recruited through secondary care have failed to demonstrate consistently which factors make for a more favourable disease course. Secondly, since most patients with PMR are managed in the community by primary care physicians, with only around 20 to 25% being referred to rheumatologists. Modelling different treatment options, pathways and strategies based on real-world data allows for testing of “what-if” scenarios. 

This PhD project will make use of 23 million individual primary care records in which 150,000 have been treated for PMR to carry out real world analysis of glucocorticoid exposure, patterns, and pathways. Secondly, we will refine these data by supplementing results from patients recruited to the recently funded STERLING trial (£1.8m NIHR HTA) testing the use of methotrexate on glucocorticoid sparing. Using these data we plan to simulate the health care delivery for patients with PMR and assess scenarios of how it might be better managed. Following this we plan a health economic decision analysis to evaluate the costs associated with the various pathways. Together these models will provide important information for policy decision makers about PMR management. 

Funding Notes

This PhD project is a Faculty of Medicine and Health Sciences competition for funded studentships. The studentships are funded for 3 years and comprise UK tuition fees, an annual stipend of £15,609 (2021/22 rate) and £1,000 per annum to support research training. International applicants (including EU) may apply but are required to fund the difference between UK and International tuition fees (details of tuition fees can be found on our website


The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population. Yates M, Graham K, Watts RA, MacGregor AJ. BMC Musculoskelet Disord. 2016 Jul 15;17:285.
Glucocorticoid withdrawal in polymyalgia rheumatica: the theory versus the practice. Yates M, Watts RA, Swords F, MacGregor AJ. Clin Exp Rheumatol. 2017 Jan-Feb;35(1):1-2
Feasibility and face validity of outcome measures for use in future studies of Polymyalgia Rheumatica (PMR): An OMERACT Study. Yates M, Owen CE, Muller S, Graham K, Neill L, Twohig H, Boers M, Pujades Rodriguez M, Goodman SM, Cheeh J, Dejaco C, Mukhtyar C, Nielsen BD, Robson J, Simon LS, Shea B, Mackie SL, Hill CL. J of Rheum. 2020 Feb;47(9):1379-1384
Variation and implications of treatment decisions in early rheumatoid arthritis: results from a nationwide cohort study. Yates M, MacGregor AJ, Ledgingham J, Norton S, Bechman K, Dennison EM, Galloway JB. Rheum 2020 Aug;59(8):2035-2042
Search Suggestions
Search suggestions

Based on your current searches we recommend the following search filters.

PhD saved successfully
View saved PhDs