Background Polymyalgia rheumatica (PMR) is a common rheumatic disorder in the elderly. However, No gold standard for the diagnosis of PMR exists. In 2012, EULAR/ACR classification criteria for PMR had been presented. This time, we compared the diagnostic accuracy between EULAR/ACR classification (scoring algorithm without Ultrasound -3 required criteria) and Bird criteria, Chuang criteria, Kyle criteria, and Nobunaga criteria for PMR.
Objectives To investigate the diagnostic accuracy including sensitivity and specificity of each criteria and coefficient of agreement. In addition Receiver-Operating Characteristic (ROC) analysis was performed.
Methods We evaluated restrospectively 80 cases that had been suspecious for PMR with the 3 positive factors or more of the Bird criteria from June 2008 to August 2014. Final diagnosis of PMR was confirmed during 26 weeks of observation.
Results Of 80 patients, 53 (66.3%) were female; average age was 74.1±8.7 years old (48-87). Following the EULAR/ACR study design, we decided the final diagnosis of PMR after 26 weeks of starting steroid treatment. Finally, PMR cases numbered 62 and non-PMR cases were 18 cases (Prevalence: 77.5%). All 80 cases were matched for the Bird criteria (sensitivity 100%, specificity 0%). 5 cases did not have creatinine kiinase measured at the initial diagnosis, Nobunaga criteria was adapted in only 75 cases.
Conclusions EULAR/ACR classification with statistical significance performed better than the other PMR criterion. This study did not include many control cases. High prevalence prevented a high κ(kappa) value with EULAR/ACR classification. From the ROC analysis, the EULAR/ACR classification had a high AUC value of 0.7133. Presently, the EULAR/ACR classification is the most reliable criteria for PMR.
Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2012 Apr;71(4):484-92.
Bird HA, Esselinckx W, Dixon AS, Mowat AG, Wood PH. An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis. 1979 Oct;38(5):434-9.
Disclosure of Interest None declared