Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Development of Classification Criteria for Polymyalgia Rheumatica (PMR): Results from an International, Prospective, Multi-Center Longitudinal Study ACREULAR Study Group for Development of Classification Criteria for PMR.

Dasgupta16,  Bhaskar, Cimmino10,  Marco A., Maradit-Kremers3,  Hilal, Schmidt19,  Wolfgang A., Schirmer5,  Michael, Salvarani5,  Carlo, Mandl20,  Peter

3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest
Department of Internal Medicine, University of Genova, Genova, Italy
Department of Rheumatology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
Department of Rheumatology, Cambridge University, Cambridge, UK
Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
Department of Rheumatology, Medical University, Graz, Graz, Austria
Department of Rheumatology, Princess Alexandra Hospital, Harlow, United Kingdom
Department of Rheumatology, Southend University Hospital, Essex, United Kingdom
Department of Systemic Autoimmune Hospital Clinic Provincial, Barcelona, Spain
Gentofte Hospital, Rheumatology Division, Hellerup, Denmark
Immanuel Krankenhaus Berlin: Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany
Center for Diagnosis Imaging, Hospital Clínic, Montserrat del Amo, Barcelona, Spain
National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
Rheumatology Associates of North Jersey, Teaneck, NJ
Rheumatology Unit, Clinica e Terapia Medica Department, Sapienza Università di Roma, Policlinico Umberto I, Rome, Italy
Rheumatology Unit, Ospedale Misericordia e Dolce, Prato, Italy
Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
Service de Medecine Interne, Amiens, France
Servicio de Reumatología, Hospital Universitario Marques de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
Department of Health Sciences Research, Mayo Clinic, Rochester, MN
Department of Internal Medicine and Rheumatology, WIM CSK MON, Warszawa, Poland
Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria
Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Jacksonville, FL
Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN
Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Scottsdale, AZ
Department of Internal Medicine, General Hospital of the Elisabethinen, Klagenfurt, Austria

Objective:

To develop ACR/EULAR classification criteria for PMR by assessing the performance of candidate criteria in a prospective longitudinal study of patients presenting with new onset bilateral shoulder pain.

Methods:

Candidate inclusion/exclusion criteria for classification of PMR and assessment of steroid response were defined through a consensus conference and a wider Delphi survey. These criteria were then evaluated in a 6-month prospective study of patients >=50 years of age including subjects with a diagnosis of new onset PMR and controls with newly diagnosed conditions mimicking PMR (i.e. new onset rheumatoid arthritis (RA), connective tissue diseases, shoulder conditions, fibromyalgia, osteoarthritis, etc.) presenting with recent onset of bilateral shoulder pain. All subjects were evaluated at baseline and week 26 resulting in reclassification of 9 PMR subjects and 4 controls. Data collection included clinical signs and symptoms, lab results, treatment details, ultrasound (US) evaluation, MHAQ, SF36, and pain rating. The c-statistic (i.e. area under receiver operating characteristic curve) was used to assess the ability of each criterion to discriminate controls from PMR subjects (based on diagnosis at week 26).

Results:

Disease features present in >80% of the 92 PMR subjects were >=2 weeks duration of symptoms, bilateral shoulder pain, morning stiffness >45 min duration and elevated c-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). 73% of PMR subjects presented with all 3 features, while only 29% of the 131 controls had all 3. Features that best discriminated RA from PMR were peripheral synovitis, abnormal rheumatoid factor (RF) or anti-citrullinated protein antibody (ACPA) and hip pain/limited range of motion (c-statistic >= 0.7). Features best discriminating shoulder conditions from PMR were hip pain/limited range of motion, morning stiffness and elevated CRP/ESR (c-statistic >= 0.7). A scoring algorithm was developed and included morning stiffness >45 min (2 points), abnormal CRP/ESR (2 points), hip pain/limited range of motion (1 point), abnormal RF or ACPA (-2 points), and other joint pain (-1 point). A score >= 3 had 76% sensitivity and 77% specificity for discriminating all controls from PMR. The specificity was higher (91%) for discriminating shoulder conditions from PMR and lower (71%) for discriminating RA from PMR. US findings were somewhat useful in discriminating PMR from shoulder conditions, but not from RA.

Conclusions:

Patients >=50 yrs old presenting with bilateral shoulder pain can be classified as having PMR in the presence of morning stiffness>45 min, elevated CRP/ESR and new hip pain in the absence of peripheral synovitis or positive RA serology.

To cite this abstract, please use the following information:
Dasgupta, Bhaskar, Cimmino, Marco A., Maradit-Kremers, Hilal, Schmidt, Wolfgang A., Schirmer, Michael, Salvarani, Carlo, et al; Development of Classification Criteria for Polymyalgia Rheumatica (PMR): Results from an International, Prospective, Multi-Center Longitudinal Study ACREULAR Study Group for Development of Classification Criteria for PMR. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1654
DOI: 10.1002/art.29419

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