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2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative
  1. Christian Dejaco1,2,
  2. Yogesh P Singh2,
  3. Pablo Perel3,
  4. Andrew Hutchings4,
  5. Dario Camellino5,
  6. Sarah Mackie6,
  7. Andy Abril7,
  8. Artur Bachta8,
  9. Peter Balint9,
  10. Kevin Barraclough10,
  11. Lina Bianconi11,
  12. Frank Buttgereit12,
  13. Steven Carsons13,
  14. Daniel Ching14,
  15. Maria Cid15,
  16. Marco Cimmino5,
  17. Andreas Diamantopoulos16,
  18. William Docken17,
  19. Christina Duftner18,
  20. Billy Fashanu2,
  21. Kate Gilbert19,
  22. Pamela Hildreth19,
  23. Jane Hollywood2,
  24. David Jayne20,
  25. Manuella Lima21,
  26. Ajesh Maharaj22,
  27. Christian Mallen23,
  28. Victor Martinez-Taboada24,
  29. Mehrdad Maz25,
  30. Steven Merry26,
  31. Jean Miller19,
  32. Shunsuke Mori27,
  33. Lorna Neill19,
  34. Elisabeth Nordborg28,
  35. Jennifer Nott19,
  36. Hannah Padbury19,
  37. Colin Pease6,
  38. Carlo Salvarani29,
  39. Michael Schirmer18,
  40. Wolfgang Schmidt30,
  41. Robert Spiera31,
  42. David Tronnier32,
  43. Alexandre Wagner33,
  44. Madeline Whitlock2,
  45. Eric L Matteson34,
  46. Bhaskar Dasgupta2
  1. 1Department of Rheumatology, Medical University Graz, Graz, Austria
  2. 2Department of Rheumatology, Southend University Hospital, Southend, UK
  3. 3Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
  4. 4Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  5. 5Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, University of Genova, Genoa, Italy
  6. 6University of Leeds, NIHR-Leeds Musculoskeletal Biomedical Research Unit and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
  7. 7Department of Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
  8. 8Department of Internal Medicine and Rheumatology, Military Institute of Medicine, Warsaw, Poland
  9. 93rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  10. 10Hoyland House General Practice, Painswick, UK
  11. 11General Practice, Bibbiano, Italy
  12. 12Department of Rheumatology, Charitè University Medicine, Berlin, Germany
  13. 13Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital Campus, Stony Brook University School of Medicine, Mineola, New York, USA
  14. 14Department of Rheumatology, Timaru Hospital, Timaru, New Zealand
  15. 15Department of Systemic Autoimmune Diseases, University of Barcelona, Hospital Clinic, Barcelona, Spain
  16. 16Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
  17. 17Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  18. 18Department of Internal Medicine—Clinic VI, Medical University of Innsbruck, Innsbruck, Austria
  19. 19Patient Representative from PMRGCAuk, UK
  20. 20Department of Medicine, University of Cambridge, Cambridge, UK
  21. 21Department of Rheumatology, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
  22. 22Department of Internal Medicine, University of Kwa Zulu Natal, Prince Mshiyeni Memorial Hospital, Nelson R Mandela School of Medicine, Durban, South Africa
  23. 23Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
  24. 24Facultad de Medicina, Servicio de Reumatología, Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Santander, Spain
  25. 25Department of Medicine, Division of Allergy, Clinical Immunology, and Rheumatology, The University of Kansas Medical Center Kansas City, Kansas, USA
  26. 26Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
  27. 27Department of Rheumatology, NHO Kumamoto Saishunsou National Hospital, Clinical Research Center for Rheumatic Diseases, Kohshi, Kumamoto, Japan
  28. 28Department of Rheumatology, Sahlgren University Hospital, Göteborg, Sweden
  29. 29Department of Internal Medicine, Division of Rheumatology, Azienda Ospedaliera-IRCCS di Reggio Emilia, Reggio Emilia, Italy
  30. 30Immanuel Krankenhaus Berlin: Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany
  31. 31Department of Medicine, Hospital for Special Surgery, New York, New York, USA
  32. 32Patient Representative from the USA
  33. 33Department of Internal Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
  34. 34Department of Health Sciences Research, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to Professor Bhaskar Dasgupta, Department of Rheumatology, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, UK; Bhaskar.dasgupta{at}southend.nhs.uk

Abstract

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients’ and clinicians’ values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.

  • Polymyalgia Rheumatica
  • Corticosteroids
  • Giant Cell Arteritis
  • Treatment
  • Patient perspective
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