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 | The diagnosis of polymyalgia rheumatica (PMR) is mostly clinical and it 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 PMR. The following criteria are required: age more than 50 years, bilateral shoulder pain, and elevated 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== | ||
* | * 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 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 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 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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===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.<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 |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 joints||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |1 | ||
|- | |- | ||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | | | 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 | | | 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 | ||
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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 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 PMR. The following criteria are required: age more than 50 years, bilateral shoulder pain, and elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR).[1]
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 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 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.