Polymyalgia rheumatica diagnostic study of choice: Difference between revisions

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==Diagnostic Criteria==
==Diagnostic Criteria==
* The European League Against Rheumatism/American College of Rheumatology collaborative initiative developed a provisional classification criteria for PMR. Each of the findings is given a point, then the total score is calculated by adding all the points. Two scores have been developed depending on whether an ultrasound is performed or not.  The criteria should be applied to subjects who have characteristic symptoms for a period less than 12 weeks and that can no be explained by an alternative diagnosis.
* The European League Against Rheumatism/American College of Rheumatology collaborative initiative developed a provisional classification criteria for PMR. Each of the findings is given a point, then the total score is calculated by adding all the points. Two scores have been developed depending on whether an ultrasound is performed or not.  The criteria should be applied to subjects who have characteristic symptoms for a period less than 12 weeks and that can no be explained by an alternative diagnosis.
* The following criteria are '''required''' in addition to the confirmatory score of the diagnostic criteria:
* The following criteria are '''required''' in addition to the confirmatory score of the diagnostic criteria:
** Age more than 50 years, AND
** Age more than 50 years, '''AND'''
** Bilateral shoulder pain, AND
** Bilateral shoulder [[pain]], '''AND'''
** 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>
** 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 more than 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>
The diagnosis of PMR requires the presence of the required criteria (age more than 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>


{| style="cellpadding=0; cellspacing= 0; width: 600px;"
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
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| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | Morning stiffness for 45 minutes|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |2
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | Morning stiffness for 45 minutes|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |2
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Pain or limited range of motion in the [[hips]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Pain]] or limited [[range of motion]] in the [[hips]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Absence of [[rheumatoid factor]] or [[anti-citrullinated protein antibody]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |2
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Absence of [[rheumatoid factor]] or [[anti-citrullinated protein antibody]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |2
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |No involvement of other joints|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |No involvement of other [[Joint|joints]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
|}
|}


===PMR Diagnostic Criteria Scoring With Ultrasound===
===PMR Diagnostic Criteria Scoring With Ultrasound===
The diagnosis of PMR requires the presence of the required criteria (age more than 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>
The diagnosis of PMR requires the presence of the required criteria (age more than 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>


{| style="cellpadding=0; cellspacing= 0; width: 600px;"
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
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| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | Morning stiffness for 45 minutes|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |2
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | Morning stiffness for 45 minutes|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |2
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Pain or limited range of motion in the hips|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Pain]] or limited [[range of motion]] in the [[hips]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Absence of [[rheumatoid factor]] or [[anti-citrullinated protein antibody]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |2
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Absence of [[rheumatoid factor]] or [[anti-citrullinated protein antibody]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |2
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |No involvement of other joints|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |No involvement of other [[Joint|joints]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Subdeltoid [[bursitis]] in at least 1 shoulder<br> AND/OR <br> Biceps [[tenosynovitis]] <br> AND/OR <br> Glenohumeral [[synovitis]] (either posterior or axillary) <br> AND <br> [[Synovitis]] and/or trochanteric [[bursitis]] in at least 1 hip|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Subdeltoid [[bursitis]] in at least 1 [[shoulder]]<br> '''AND/OR''' <br> Biceps [[tenosynovitis]] <br> '''AND/OR''' <br> Glenohumeral [[synovitis]] (either posterior or axillary) <br> '''AND''' <br> [[Synovitis]] and/or trochanteric [[bursitis]] in at least 1 hip|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Subdeltoid [[bursitis]], biceps [[tenosynovitis]], or glenohumeral [[synovitis]] in both shoulders|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Subdeltoid [[bursitis]], biceps [[tenosynovitis]], or glenohumeral [[synovitis]] in both [[Shoulder|shoulders]]|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1
|-
|-
|}
|}

Revision as of 18:05, 8 May 2018

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

Diagnostic Criteria

  • The European League Against Rheumatism/American College of Rheumatology collaborative initiative developed a provisional classification criteria for PMR. Each of the findings is given a point, then the total score is calculated by adding all the points. Two scores have been developed depending on whether an ultrasound is performed or not. The criteria should be applied to subjects who have characteristic symptoms for a period less than 12 weeks and that can no be explained by an alternative diagnosis.
  • The following criteria are required in addition to the confirmatory score of the diagnostic criteria:
    • Age more than 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 more than 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 more than 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
Subdeltoid bursitis in at least 1 shoulder
AND/OR
Biceps tenosynovitis
AND/OR
Glenohumeral synovitis (either posterior or axillary)
AND
Synovitis and/or trochanteric bursitis in at least 1 hip
1
Subdeltoid bursitis, biceps tenosynovitis, or glenohumeral synovitis in both shoulders 1

References

  1. 1.0 1.1 1.2 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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