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2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative
  1. Bhaskar Dasgupta1,
  2. Marco A Cimmino2,
  3. Hilal Maradit-Kremers3,
  4. Wolfgang A Schmidt4,
  5. Michael Schirmer5,
  6. Carlo Salvarani6,
  7. Artur Bachta7,
  8. Christian Dejaco8,
  9. Christina Duftner5,9,
  10. Hanne Slott Jensen10,
  11. Pierre Duhaut11,
  12. Gyula Poór12,
  13. Novák Pál Kaposi13,
  14. Peter Mandl14,
  15. Peter V Balint14,
  16. Zsuzsa Schmidt12,
  17. Annamaria Iagnocco15,
  18. Carlotta Nannini16,
  19. Fabrizio Cantini16,
  20. Pierluigi Macchioni6,
  21. Nicolò Pipitone6,
  22. Montserrat Del Amo17,
  23. Georgina Espígol-Frigolé18,
  24. Maria C Cid18,
  25. Víctor M Martínez-Taboada19,
  26. Elisabeth Nordborg20,
  27. Haner Direskeneli21,
  28. Sibel Zehra Aydin21,
  29. Khalid Ahmed22,
  30. Brian Hazleman23,
  31. Barbara Silverman23,
  32. Colin Pease24,
  33. Richard J Wakefield24,
  34. Raashid Luqmani25,
  35. Andy Abril26,
  36. Clement J Michet27,
  37. Ralph Marcus28,
  38. Neil J Gonter28,
  39. Mehrdad Maz29,
  40. Rickey E Carter3,
  41. Cynthia S Crowson3,27,
  42. Eric L Matteson3,27
  1. 1Department of Rheumatology, Southend University Hospital, Westcliff-on-Sea, Essex, UK
  2. 2Department of Internal Medicine, University of Genova, Genova, Italy
  3. 3Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Department of Rheumatology, Immanuel Krankenhaus Berlin: Medical Center for Rheumatology Berlin–Buch Berlin, Berlin, Germany
  5. 5Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
  6. 6Department of Rheumatology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
  7. 7Department of Internal Medicine and Rheumatology, Military Institute of Medicine, Warsaw, Poland
  8. 8Department of Rheumatology, Medical University Graz, Graz, Austria
  9. 9Department of Internal Medicine, General Hospital of Kufstein, Kufstein, Austria
  10. 10Gentofte Hospital, Rheumatology Division, Hellerup, Denmark
  11. 11Service de Médecine Interne, Amiens, France
  12. 12National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  13. 13Radiology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  14. 14General and Pediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  15. 15Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
  16. 16Rheumatology Unit, Ospedale Misericordia e Dolce, Prato, Italy
  17. 17Center for Diagnosis Imaging, Hospital Clínic, Barcelona, Spain
  18. 18Department of Systemic Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
  19. 19Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
  20. 20Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
  21. 21Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
  22. 22Department of Rheumatology, Princess Alexandra Hospital, Harlow, UK
  23. 23Department of Rheumatology, Addenbrookes Hospital, Cambridge, UK
  24. 24Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
  25. 25Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
  26. 26Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
  27. 27Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
  28. 28Rheumatology Associates of North Jersey, Teaneck, New Jersey, USA
  29. 29Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona, USA
  1. Correspondence to Eric L Matteson, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota, USA; matteson.eric{at}mayo.edu

Abstract

The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of RF and/or ACPA (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness>45 minutes, elevated CRP and/or ESR and new hip pain. These criteria are not meant for diagnostic purposes.

This paper is freely available online under the BMJ Journals unlocked scheme, see http://ard.bmj.com/info/unlocked.dtl

https://doi.org/10.1136/annrheumdis-2011-200329

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    Footnotes

    • This article is published simultaneously in the April 2012 issue of Arthritis & Rheumatism.

    • Funding Funding for this study was provided by EULAR, ACR, the Mayo Foundation, and was supported further by the individual and uncompensated efforts of participating investigators and their staffs and institutions, and the Biobanque de Picardie in Amiens, France. GE-F and MCC were supported by Ministerio de Ciencia y Tecnologia (SAF 08/04328).

    • Competing interests None.

    • Ethics approval The study was approved by the ethics boards of the participating investigor institutions, which are listed.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.