2012 Provisional classification criteria for polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative

TLDR

The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). The authors evaluated candidate criteria in a 6‑month prospective cohort of 125 new‑onset PMR patients and 169 comparison subjects, then derived a scoring algorithm assigning points for morning stiffness >45 min, hip pain/limited ROM, absence of RF/ACPA, and absence of peripheral joint pain, and defined provisional criteria that classify patients ≥50 years with bilateral shoulder pain, morning stiffness >45 min, elevated CRP/ESR, and new hip pain as having PMR. A score of ≥4 yielded 68 % sensitivity and 78 % specificity for distinguishing PMR from other conditions, with higher specificity (88 %) for shoulder disorders and lower (65 %) for RA, and adding ultrasound raised sensitivity to 66 % and specificity to 81 %; the criteria are intended for classification, not diagnosis.

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.