Performance of the polymyalgia rheumatica activity score for diagnosing disease flares

Abstract

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

Outcome Measures in Polymyalgia Rheumatica. A Systematic Review

“…The electronic search strategy yielded 868 articles, 43 of which were selected, on the basis of title and abstract, for further assessment/detailed review. Ultimately, 35 studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]42,43,44,45,46 met inclusion criteria for this systematic review (Figure 1). Agreement between the 2 reviewers was 96.6% and 100% for the first and second steps of article selection, respectively.…”

“…Three are nonrandomized interventional studies or ones without clear information about randomization 24,25,26 . Longitudinal observational studies represent more than one-half of selected articles (20 of 35) [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] . One of these observational studies 36 is a longterm followup of an already included RCT 20 .…”

“…Morning stiffness. Stiffness, more commonly morning stiffness, was considered in almost all the included studies 13,14,15,16,18,19,20,21,22,24,25,26,27,28,30,33,34,35,36,37,38,40,43,44,45,46 . It was evaluated as an independent outcome in 11 studies 13,14,15,16,18,19,25,27,34,40,44 , and was included as a variable in composite disease activity scores or in the definition of relapse/recurrence/remission in an additional 15 studies 19,20,22,24,26,28,33,35,36,37,38,43,…”

“…Patient and physician global assessment. Patient Global Assessment (PGA) of disease activity was measured in 9 studies 13,19,22,25,27,33,35,38,46 , always as a 0-10 cm VAS except in 2 studies 13,17 , where a 5-point ordinal scale was used.…”

“…Physician Global Assessment (PhGA) was used in 14 studies 12,13,19,22,25,27,33,35,36,38,43,44,45,46 , 12 of them as a 0-10 cm VAS and 2 13,27 as 5-point ordinal scales.…”