Polymyalgia rheumatica diagnostic study of choice: Difference between revisions

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Revision as of 18:05, 8 May 2018

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

↑ ^1.0 ^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.

Template:WH Template:WS

[pmid22388996-1] 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.

[1]

@@ Line 7: / Line 7: @@
 ==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:
-** 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===
-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;"
@@ Line 22: / Line 22: @@
 | 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" |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===
-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;"
@@ Line 38: / Line 38: @@
 | 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" |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
 |-
 |}