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Validity of the Polymyalgia Rheumatica Activity Score in primary care practice
  1. Aymeric Binard (aymeric.binard{at}chu-brest.fr)
  1. Department of Rheumatology, CHU Brest, France
    1. Benjamin Lefebvre (benjaminlefebvre76000{at}hotmail.com)
    1. Department of Rheumatology, CHU Brest, France
      1. Michel Debandt (m.debandt{at}ch-aulnay.fr)
      1. Rheumatology Unit, Robert Ballanger Hospital, Aulnay sous Bois, France
        1. Jean M Berthelot (jeanmarie.berthelot{at}chu-nantes.fr)
        1. Rheumatology Unit, Nantes Teaching Hospital, France
          1. Alain Saraux (alain.saraux{at}chu-brest.fr)
          1. Department of Rheumatology, CHU Brest, France

            Abstract

            Objective: To evaluate the validity and reliability of the polymyalgia rheumatica (PMR) activity score (PMR-AS) for relapse diagnosis by GPs, who manage a large proportion of patients with PMR.

            Methods: We used seven clinical vignettes of PMR, for which 35 rheumatologists previously made a diagnosis of relapse or no relapse with greater than 80% agreement. These vignettes were submitted to 163 general practitioners (GPs), who were asked to assess disease activity using a visual analog scale (VASph), this being the only physician-dependent component of the PMR-AS. We used the 1116 available vignette-GP combinations to assess differences in VASph assessed by GPs versus rheumatologists. We evaluated statistical associations linking a relapse diagnosis by the rheumatologists (the reference standard) to the value of the GP-assessed PMR-AS or its components (GP-assessed VASph, VAS pain score, C-reactive protein, morning stiffness, and elevation of upper limbs).

            Results: We found no significant differences between VASph scores by GPs versus rheumatologists for any of the vignettes. A relapse diagnosis was strongly associated with PMR-AS≥7 (sensitivity, 99.4%; specificity, 93.3%; agreement, 95.9% [95CI, 94.5-97.0%] with κ=0.92). Of the 590 GP-vignette combinations with PMR-AS values lower 7, all but 3 (0.5%) had no relapse diagnosis. Of 510 combinations with PMR-AS values of 7 or more, only 42 (8%) had no flare diagnosis.

            Conclusions: This study supports the validity of PMR-AS in primary care practice and provides evidences that a good scoring system can be useful to guide clinical and therapeutic decisions.

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