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The diagnosis of polymyalgia rheumatica

Issue 36 Synovium (Summer 2012)

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Diagnosing polymyalgia rheumatica (PMR) is often a challenge for the primary care clinician so the recent publication of provisional classification criteria will be welcomed. This was a joint piece of work by the European League against Rheumatism (EULAR) and the American College of Rheumatology (ACR), published online in March 2012 and in the printed April issues of both Arthritis & Rheumatism and the Annals of the Rheumatic Diseases.1 Please note that at present the status of the following criteria is described as provisional, pending validation. The authors also state that these criteria are at present intended for research purposes only. The criteria do however give the primary care clinician a little more to go on than clinical intuition. They are:

  • age ≥50 years
  • bilateral shoulder aching
  • abnormal C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR)
  • plus at least 4 points from the following:
    • morning stiffness that lasts >45 minutes (2 points)
    • hip pain or limited range of motion (1 point)
    • absence of rheumatoid factor and/or anticitrullinated protein antibody (2 points)
    • absence of peripheral synovitis (1 point).

There are further criteria to be added if office ultrasound scanning is available – this will not be relevant to the majority of UK primary care physicians so these criteria have been omitted here. It is also particularly noteworthy that a response to steroid medication is not included as this is regarded as non-specific, as most rheumatological conditions will respond to a steroid trial.

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