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==Overview==
==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).
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).<ref name="pmid22388996">{{cite journal| author=Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C et al.| title=2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. | journal=Ann Rheum Dis | year= 2012 | volume= 71 | issue= 4 | pages= 484-92 | pmid=22388996 | doi=10.1136/annrheumdis-2011-200329 | pmc=PMC3298664 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22388996  }} </ref>


==Diagnostic Criteria==
==Diagnostic Criteria==
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** Age 50 years, AND
** Age 50 years, AND
** Bilateral shoulder pain, AND
** Bilateral shoulder pain, AND
** Elevated CRP and/or ESR
** Elevated CRP and/or ESR<ref name="pmid22388996">{{cite journal| author=Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C et al.| title=2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. | journal=Ann Rheum Dis | year= 2012 | volume= 71 | issue= 4 | pages= 484-92 | pmid=22388996 | doi=10.1136/annrheumdis-2011-200329 | pmc=PMC3298664 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22388996  }} </ref>


===PMR Diagnostic Criteria Scoring Without Ultrasound===
===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.
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.<ref name="pmid22388996">{{cite journal| author=Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C et al.| title=2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. | journal=Ann Rheum Dis | year= 2012 | volume= 71 | issue= 4 | pages= 484-92 | pmid=22388996 | doi=10.1136/annrheumdis-2011-200329 | pmc=PMC3298664 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22388996  }} </ref>


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===PMR Diagnostic Criteria Scoring With Ultrasound===
===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.
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.<ref name="pmid22388996">{{cite journal| author=Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C et al.| title=2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. | journal=Ann Rheum Dis | year= 2012 | volume= 71 | issue= 4 | pages= 484-92 | pmid=22388996 | doi=10.1136/annrheumdis-2011-200329 | pmc=PMC3298664 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22388996  }} </ref>


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Revision as of 22:38, 1 June 2014

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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).[1]

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[1]

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.[1]

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.[1]

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

References

  1. 1.0 1.1 1.2 1.3 Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C; et al. (2012). "2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative". Ann Rheum Dis. 71 (4): 484–92. doi:10.1136/annrheumdis-2011-200329. PMC 3298664. PMID 22388996.

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