Polymyalgia rheumatica diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

The diagnosis of PMR is mostly clinical and is supported with an elevated ESR and specific findings on ultrasound of the affected joints. The European League Against Rheumatism/American College of Rheumatology collaborative initiative developed a provisional classification criteria for polymyalgia rheumatica. The following criteria are required: age 50 years, bilateral shoulder aching, and abnormal C-reactive protein (CRP and/or erythrocyte sedimentation rate (ESR).

Diagnostic Criteria

• Shown below is the 2012 provisional classification criteria for polymyalgia rheumatica by the European League Against Rheumatism/American College of Rheumatology collaborative initiative. Each of the findings is given a point, then the total score is calculated by adding all the point. Two scores have been developed depending on whether an ultrasound is performed or not.
• The following criteria are required in addition to the confirmatory score of the diagnostic criteria:
  • Age 50 years, AND
  • Bilateral shoulder pain, AND
  • Elevated CRP and/or ESR

PMR Diagnostic Criteria Scoring Without Ultrasound

The diagnosis of PMR requires the presence of the required criteria (age 50 years, bilateral shoulder pain, and elevated CRP and/or ESR) PLUS a score of ≥ 4.

Variable	Points
Morning stiffness for 45 minutes	2
Pain or limited range of motion in the hips	1
Absence of rheumatoid factor or anti-citrullinated protein antibody	2
No involvement of other joints	1

PMR Diagnostic Criteria Scoring With Ultrasound

The diagnosis of PMR requires the presence of the required criteria (age 50 years, bilateral shoulder pain, and elevated CRP and/or ESR) PLUS a score of ≥ 5.

Variable	Points
Morning stiffness for 45 minutes	2
Pain or limited range of motion in the hips	1
Absence of rheumatoid factor or anti-citrullinated protein antibody	2
No involvement of other joints	1
At least 1 shoulder with subdeltoid bursitis AND/OR biceps tenosynovitis AND/OR Glenohumeral synovitis (either posterior or axillary) AND at least 1 hip with synovitis and/or trochanteric bursitis	1
Both shoulders with subdeltoid bursitis, biceps tenosynovitis, or glenohumeral synovitis	1