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 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.