Polymyalgia rheumatica diagnostic study of choice: Difference between revisions
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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
- ↑ 1.0 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.