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Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus
  1. Christian Dejaco1,
  2. Christina Duftner2,3,
  3. Marco A Cimmino4,
  4. Bhaskar Dasgupta5,
  5. Carlo Salvarani6,
  6. Cynthia S Crowson7,
  7. Hilal Maradit-Kremers7,
  8. Andrew Hutchings8,
  9. Eric L Matteson7,
  10. Michael Schirmer3,
  11. and members of the International Work Group for PMR and GCA
  1. 1Department of Rheumatology, Medical University Graz, Graz, Austria
  2. 2Department of Internal Medicine, General Hospital of Kufstein, Kufstein, Austria
  3. 3Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
  4. 4Department of Internal Medicine, University of Genova, Genova, Italy
  5. 5Department of Rheumatology, Southend University Hospital, Essex, UK
  6. 6Department of Rheumatology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
  7. 7Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
  8. 8Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Professor Michael Schirmer, Department of Internal Medicine I, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; michael.schirmer{at}


Objective To compare current definitions of remission and relapse in polymyalgia rheumatica (PMR) with items resulting from a Delphi-based expert consensus.

Methods Relevant studies including definitions of PMR remission and relapse were identified by literature search in PubMed. The questionnaire used for the Delphi survey included clinical (n=33), laboratory (n=54) and imaging (n=7) parameters retrieved from a literature search. Each item was assessed for importance and availability/practicability, and limits were considered for metric parameters. Consensus was defined by an agreement rate of ≥80%.

Results Out of 6031 articles screened, definitions of PMR remission and relapse were available in 18 and 34 studies, respectively. Parameters used to define remission and/or relapse included history and clinical assessment of pain and synovitis, constitutional symptoms, morning stiffness (MS), physician's global assessment, headache, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood count, fibrinogen and/or corticosteroid therapy. In the Delphi exercise a consensus was obtained on the following parameters deemed essential for definitions of remission and relapse: patient's pain assessment, MS, ESR, CRP, shoulder and hip pain on clinical examination, limitation of upper limb elevation, and assessment of corticosteroid dose required to control symptoms.

Conclusions Assessment of patient's pain, MS, ESR, CRP, shoulder pain/limitation on clinical examination and corticosteroid dose are considered to be important in current available definitions of PMR remission and relapse and the present expert consensus. The high relevance of clinical assessment of hips was unique to this study and may improve specificity and sensitivity of definitions for remission and relapse in PMR.

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  • Competing interests None.

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

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