An evaluation of criteria for polymyalgia rheumatica.

Bird, H. A.; Esselinckx, Walter; Dixon, A. St. J.; Mowat, A G; Wood, Paul T.

doi:10.1136/ard.38.5.434

Cited by 433 publications

(212 citation statements)

References 7 publications

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“…Initial features vary, e.g., PMR without an elevated erythrocyte sedimentation rate (ESR) (3), and common mimicking conditions can present with the polymyalgic syndrome (4). There is no gold standard test and several diagnostic criteria have been used (5)(6)(7)(8). This may explain the lack of agreement in PMR diagnoses between primary care physicians and rheumatologists (9 -11) and the revision of diagnoses in 5-23% of patients with longterm followup (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica

Hutchings¹,

Hollywood²,

Lamping³

et al. 2007

Arthritis & Rheumatism

122

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Objective. To evaluate the impact of polymyalgia rheumatica (PMR) on clinical outcomes and quality of life (QOL); the relationship between laboratory measures and clinical outcomes, and changes in QOL; and agreement between rheumatologists in confirming the initial diagnosis. Methods. We conducted a prospective study of 129 participants in 8 hospitals in England who met a modified version of the Jones and Hazleman criteria and had not started steroid therapy. The main outcome measures were response to steroids after 3 weeks (minimum 50% improvement in proximal pain, morning stiffness <30 minutes, acute-phase response not elevated), relapses, QOL as measured by the Short Form 36 and Health Assessment Questionnaire, and diagnosis reassessment at 1 year. Results. At 3 weeks, 55% of participants failed to meet our definition of a complete response to steroid therapy. Both physical and mental QOL at presentation were substantially lower than general population norms and improved by 12.6 (95% confidence interval [95% CI] 10.8, 14.4) and 11.2 (95% CI 8.5, 13.8) points, respectively, at 1 year. Proximal pain and longer morning stiffness were significantly associated with lower physical QOL during followup, whereas erythrocyte sedimentation rate was most strongly associated with lower mental QOL during followup. There was moderate agreement between clinicians in confirming the PMR diagnosis (kappa coefficients 0.49 -0.65). Conclusion. PMR is a heterogeneous disease with a major impact on QOL. Ongoing monitoring should include disease activity based on symptoms, emergence of alternative diagnoses, and early referral of atypical and severe cases.

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Section: Introductionmentioning

confidence: 99%

Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica

Hutchings¹,

Hollywood²,

Lamping³

et al. 2007

Arthritis & Rheumatism

122

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“…1 Elevated ESR is also common in infections, can serve as a useful aid in the diagnosis of various clinical conditions, and has been shown to correlate with an unfavorable prognosis in neoplastic diseases and coronary artery disease. [2][3][4][5] In addition, serial ESR measurements allow monitoring the efficacy of therapeutic interventions ͑e.g., in rheumatoid arthritis͒. Although ESR is a commonly ordered laboratory test, it has several limitations: ͑1͒ slow turnaround time since the measurement alone takes 60 min to perform; ͑2͒ it is an open tube system and thus has biohazard risks; and ͑3͒ inaccurate results are possible due to nonvertical tube positioning or inaccurate/delayed reading.…”

Section: Introductionmentioning

confidence: 99%

A rapid method to estimate Westergren sedimentation rates

Alexy

Pais

Meiselman

2009

Review of Scientific Instruments

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The erythrocyte sedimentation rate ͑ESR͒ is a nonspecific but simple and inexpensive test that was introduced into medical practice in 1897. Although it is commonly utilized in the diagnosis and follow-up of various clinical conditions, ESR has several limitations including the required 60 min settling time for the test. Herein we introduce a novel use for a commercially available computerized tube viscometer that allows the accurate prediction of human Westergren ESR rates in as little as 4 min. Owing to an initial pressure gradient, blood moves between two vertical tubes through a horizontal small-bore tube and the top of the red blood cell ͑RBC͒ column in each vertical tube is monitored continuously with an accuracy of 0.083 mm. Using data from the final minute of a blood viscosity measurement, a sedimentation index ͑SI͒ was calculated and correlated with results from the conventional Westergren ESR test. To date, samples from 119 human subjects have been studied and our results indicate a strong correlation between SI and ESR values ͑R 2 = 0.92͒. In addition, we found a close association between SI and RBC aggregation indices as determined by an automated RBC aggregometer ͑R 2 = 0.71͒. Determining SI on human blood is rapid, requires no special training and has minimal biohazard risk, thus allowing physicians to rapidly screen for individuals with elevated ESR and to monitor therapeutic responses.

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“…However, none of the study patients was later diagnosed with another condition. Even the best criteria for PMR (12), including the Bird et al criteria (13) or Chuang et al criteria (14), lack sensitivity and specificity. There is no consensus about diagnoses that must be ruled out or investigations that must be performed before diagnosing PMR.…”

Section: Discussionmentioning

confidence: 99%

Performance of the polymyalgia rheumatica activity score for diagnosing disease flares

Binard¹,

Bandt

Berthelot

et al. 2008

Arthritis & Rheumatism

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Objective. To evaluate the effectiveness of the polymyalgia rheumatica activity score (PMR-AS) in diagnosing disease flares. Methods. Rheumatologists prospectively included 89 patients with PMR (mean ؎ SD age 74.6 ؎ 6.2 years, mean ؎ SD disease duration 1.6 ؎ 2.2 years). At each visit, the rheumatologist assessed disease activity using a visual analog scale (VAS) and recorded whether a disease flare was diagnosed and/or the glucocorticoid dose changed. Overall, 137 visits including 49 pairs (allowing intraindividual comparisons) were available; a disease flare was diagnosed at 32 visits. We evaluated statistical associations linking flare diagnosis to the PMR-AS, each of its components (VAS, VAS for pain, C-reactive protein, morning stiffness, and elevation of upper limbs), and changes in these parameters between 2 visits. Results. Associations with disease flare diagnosis were strongest for PMR-AS scores

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An evaluation of criteria for polymyalgia rheumatica.

Cited by 433 publications

References 7 publications

Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica

Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica

A rapid method to estimate Westergren sedimentation rates

Performance of the polymyalgia rheumatica activity score for diagnosing disease flares

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