Baseline comorbidity assessment may authorize early steroid-sparing therapy in older patients with polymyalgia rheumatica.

Glucocorticoids remain the cornerstone of polymyalgia rheumatica (PMR) management, but prolonged use carries significant toxicity risks in older adults. Despite high multi-morbidity prevalence, systematic screening using validated geriatric scales is rarely performed. We evaluated whether baseline systemic comorbidity burden, quantified via the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), is associated with persistent glucocorticoid utilization at 12 months. In this perspective report of 154 older outpatients (mean age 71.74 years) with isolated PMR, baseline comorbidity density maintained a significant exploratory association with 12-month persistent glucocorticoid requirements (adjusted OR 1.11, 95% CI 1.05-1.16; P < 0.001), while the isolated severity score lost significance. Partitioning the cohort into true empirical population tertiles revealed that persistent therapy requirements rose from 1.96% (scores ≤ 21) to 44.23% (scores > 25, P < 0.001). A scales-based comorbidity assessment offers a practical operationalization of the 2024 EULAR/ACR Treat-to-Target recommendations, optimizing baseline risk stratification during weaning.