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 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

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.

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.

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