Background The BSR recommends for the diagnosis and management of polymyalgia rheumatica (PMR) blood cells count, blood electrolytes and renal function, liver function, bone metabolism tests, thyroid hormones, muscle enzymes, rheumatoid serology, plasma proteins electrophoresis, erythrocyte sedimentation rate and C-reactive protein, chest X-ray and urine analysis (1).
Objectives To conduct a practice survey of laboratory and imaging studies used by French physicians (rheumatology or internal medicine) to diagnose PMR.
Methods 101 rheumatologists or internal medicine physicians (74 in western region and a random sample of 27 in other regions) were asked 1- to recruit one patient with PMR and to record laboratory and imaging studies performed and 2- answer to a questionnaire describing a paper-case of PMR. Results were analysed in the overall group and in clinical presentation subgroups [typical, atypical PMR (fatigue, weight loss, fever, synovitis and swelling of the dorsal hand) and associated to giant cell arteritis]. To simplify the reporting of results, we divided the investigations into four groups based on whether they were obtained in 0% to 24%, 25% to 49%, 50% to 74%, or 75% to 100%) of patients.
Results 101 physicians responded to the questionnaire and included one patient (mean age 74.3yrs, 19% had fever, 13% clinical signs of GCA, 12% synovitis and 4% hand dorsal edema). Investigations done in more than 50% of the 101 patients (recruited patients or paper-case) were blood cell count and platelets; kidney and liver function test; bone metabolism (calcium, phosphorus and vitamin D); protein serum electrophoresis; creatine phosphokinase, rheumatoid factors and ACPA, X-Rays (shoulders, pelvis, hands, feet, chest). No differences were found between investigations in patients with typical PMR and the remainder excepted hand X-rays (for synovitis), CT-Scan, echocardiography, ANCA, urine and hemocultures (for fever), and temporal artery biopsy (for suspicion of Giant cell arteritis).
Conclusions Although considerable variability occurred, this study suggests that a limited panel of laboratory and imaging studies (close to the BSR recommendation) is recommended by at least 50% of the physicians to the patients with PMR in France.
Dasgupta B, Borg FA, Hassan N, Barraclough K, Bourke B, Fulcher J, et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford). 2010;49(1):186–90.
Disclosure of Interest None Declared