Criteria
There have been a number of similar sets of diagnostic criteria proposed for PMR, none of which has been accepted as a universal standard. These are as follows.
An evaluation of criteria for polymyalgia rheumatica[41]
Criteria: must have any 3 factors, or just 1 and a temporal artery biopsy positive for giant cell arteritis
Age over 65 years
Bilateral shoulder girdle pain
More than 1 hour morning stiffness
Symptom onset <2 weeks
ESR >40 mm/hour
Depression/weight loss
Upper arm tenderness, bilateral.
Prognosis and management of polymyalgia rheumatica[27]
Criteria: all required
Bilateral shoulder girdle and pelvic girdle pain
Morning stiffness of any duration
Greater than 2 months
ESR >30 mm/hour or CRP protein >6 mg/L
Other diagnoses excluded
Rapid improvement with corticosteroids.
Polymyalgia rheumatica: a 10-year epidemiologic and clinical study[42]
Criteria: all required
Age over 50 years
Bilateral neck, shoulder girdle, or pelvic girdle pain (need 2 of 3 factors)
Greater than 30 minutes of morning stiffness
More than 1 month duration of symptoms
ESR >40 mm/hour
Other diagnoses excluded.
Long-term follow-up of polymyalgia rheumatica: evidence for synovitis[43]
Criteria: age and duration required with any 3 of the remaining factors
Age over 50 years
Bilateral neck, shoulder girdle, or pelvic girdle pain
More than 1 hour morning stiffness
More than 1 month duration of symptoms
ESR above upper limit of normal
Other diagnoses excluded
Rapid improvement with <20 mg of prednisone.
Provisional classification criteria for polymyalgia rheumatica[44]
The lack of definitive classification criteria for PMR presents a problem for patient evaluation in clinical studies and the development of reliable diagnostic criteria. The European League Against Rheumatism and the American College of Rheumatology established a collaborative working group to develop classification criteria for PMR. A set of consensus-based criteria were developed over several years via a multistep process. These criteria were used prospectively comparing new-onset PMR patients with a control group with conditions mimicking patients with PMR. The results were then used to generate a scoring algorithm for the classification of PMR. The criteria (all required) and proposed algorithm are as follows:
Age 50 years or over
Bilateral shoulder aching
Abnormal CRP and/or ESR.[Figure caption and citation for the preceding image starts]: Scoring algorithm for the classification of PMRAdapted from Dasgupta B, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012:64:943-954 [Citation ends].
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