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Bhaskar Dasgupta,
Marco A Cimmino,
Hilal Maradit-Kremers,
Wolfgang A Schmidt,
Michael Schirmer,
Carlo Salvarani,
Artur Bachta,
Christian Dejaco,
Christina Duftner,
Hanne Slott Jensen, [......],
Richard J Wakefield, Raashid Luqmani,
Andy Abril,
Clement J Michet,
Ralph Marcus,
Neil J Gonter,
Mehrdad Maz,
Rickey E Carter,
Cynthia S Crowson,
Eric L Matteson
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ABSTRACT: The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of RF and/or ACPA (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness>45 minutes, elevated CRP and/or ESR and new hip pain. These criteria are not meant for diagnostic purposes.
Annals of the rheumatic diseases 04/2012; 71(4):484-92. · 8.11 Impact Factor
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Bhaskar Dasgupta,
Marco A Cimmino,
Hilal Maradit Kremers,
Wolfgang A Schmidt,
Michael Schirmer,
Carlo Salvarani,
Artur Bachta,
Christian Dejaco,
Christina Duftner,
Hanne Slott Jensen, [......],
Richard J Wakefield, Raashid Luqmani,
Andy Abril,
Clement J Michet,
Ralph Marcus,
Neil J Gonter,
Mehrdad Maz,
Rickey E Carter,
Cynthia S Crowson,
Eric L Matteson
[show abstract]
[hide abstract]
ABSTRACT: The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of rheumatoid factor and/or anti-citrullinated protein antibody (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness >45 minutes, elevated C-reactive protein and/or erythrocyte sedimentation rate, and new hip pain. These criteria are not meant for diagnostic purposes.
Arthritis & Rheumatism 04/2012; 64(4):943-54. · 7.87 Impact Factor
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Eric L Matteson,
Hilal Maradit-Kremers,
Marco A Cimmino,
Wolfgang A Schmidt,
Michael Schirmer,
Carlo Salvarani,
Artur Bachta,
Christian Dejaco,
Christina Duftner,
Hanne Slott Jensen, [......],
Brian Hazelman,
Colin Pease,
Richard J Wakefield, Raashid Luqmani,
Andy Abril,
Ralph Marcus,
Neil J Gonter,
Mehrdad Maz,
Cynthia S Crowson,
Bhaskar Dasgupta
[show abstract]
[hide abstract]
ABSTRACT: To prospectively evaluate the disease course and the performance of clinical, patient-reported outcome (PRO) and musculoskeletal ultrasound measures in patients with polymyalgia rheumatica (PMR).
The study population included 85 patients with new-onset PMR who were initially treated with prednisone equivalent dose of 15 mg daily tapered gradually, and followed for 26 weeks. Data collection included physical examination findings, laboratory measures of acute-phase reactants, and PRO measures. Ultrasound evaluation was performed at baseline and Week 26 to assess for features previously reported to be associated with PMR. Response to corticosteroid treatment was defined as 70% improvement in PMR on visual analog scale (VAS).
At baseline, 77% had hip pain in addition to shoulder pain and 100% had abnormal C-reactive protein or erythrocyte sedimentation rate. On ultrasound, 84% had shoulder findings and 32% had both shoulder and hip findings. Response to corticosteroid treatment occurred in 73% of patients by Week 4 and was highly correlated with percentage improvement in other VAS measures. Presence of ultrasound findings at baseline predicted response to corticosteroids at 4 weeks. Factor analysis revealed 6 domains that sufficiently represented all the outcome measures: PMR-related pain and physical function, an elevated inflammatory marker, hip pain, global pain, mental function, and morning stiffness.
PRO measures and inflammatory markers performed well in assessing disease activity in patients with PMR. A minimum set of outcome measures consisting of PRO measures of pain and function and an inflammatory marker should be used in practice and in clinical trials in PMR.
The Journal of Rheumatology 03/2012; 39(4):795-803. · 3.69 Impact Factor
