Materiały źródłowe

• #1 Polymyalgia rheumatica: clinical update

  https://www.racgp.org.au/afp/2014/june/polymyalgia-rheumatica

  Polymyalgia rheumatica is a relatively common inflammatory rheumatic disease. There are no validated international guidelines available for the diagnosis and treatment of PMR; however, diagnostic and classification criteria are currently being developed. Diagnosis is made on the basis of a combination of clinical and laboratory findings. Patients typically present with shoulder and hip girdle pain with pronounced stiffness. Inflammatory markers are usually elevated and an ultrasound and MRI of the shoulder and hip can be done to localise inflamed tissues. […] Key differences between the existing BSR criteria and the new EULAR/ACR criteria include the absence of response to steroid treatment (this was not found to have sufficient discriminating value to be included) and the addition of shoulder and hip abnormalities on ultrasound.

• #2 Polymyalgia Rheumatica | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/polymyalgia-rheumatica/

  Diagnosing polymyalgia rheumatica and other rheumatic diseases can be difficult because the diseases share many common symptoms. […] Our rheumatologists have extensive experience in diagnosing and treating diseases that affect joints, bones, muscles, and the immune system, and we conduct a comprehensive evaluation that includes: […] To confirm a diagnosis of polymyalgia rheumatica, our doctors might recommend one or more tests, such as: […] Blood test to look for signs of inflammation, the bodys natural response to illness or injury, such as high levels of C-reactive protein or an elevated erythrocyte sedimentation rate […] Magnetic resonance imaging (MRI) scan of joints to look for other causes of shoulder and hip pain […] Ultrasound to distinguish between polymyalgia rheumatica and other conditions with similar symptoms.

• #3 Polymyalgia Rheumatica: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/25215-polymyalgia-rheumatica

  Polymyalgia rheumatica diagnosis can be difficult for a healthcare provider to make because the condition is similar to several other medical conditions, such as rheumatoid arthritis, spondyloarthritis, pseudogout, myositis and other connective tissue diseases as well as degenerative joint disease. Your provider will have to rule out these other conditions before making a diagnosis. […] Your provider will ask about your medical history and perform a physical examination. During the exam, they’ll look for the presence of common polymyalgia rheumatica features and those of other possible illnesses. […] There’s no specific blood test for polymyalgia rheumatica, but your provider will order a series of tests that help them find or rule out other conditions. Blood tests may include: Complete blood count (CBC), C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Thyroid-stimulating hormone (TSH), Creatine kinase. […] Your provider may also be able to diagnose polymyalgia rheumatica based on how quickly you respond to corticosteroids (steroids). Most people with the condition feel much better within a few days of starting a low dose of prednisone.

• #4 A new dawn for polymyalgia rheumatica: from diagnosis to emerging treatments | Medicine Today

  https://medicinetoday.com.au/mt/2024/jan-feb/feature-article/new-dawn-polymyalgia-rheumatica-diagnosis-emerging-treatments

  There has been little change in diagnostic and management approaches for polymyalgia rheumatica (PMR) since the 1950s. […] With recent US FDA approval of the first biologic agent for relapsing disease, modern medicine may soon become a reality for patients with PMR. […] Although no specific autoantibody exists for PMR diagnosis, the diagnostic approach should exclude relevant differential diagnoses, such as rheumatoid arthritis, and may be complemented by modern imaging techniques such as ultrasound, MRI and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. […] This article discusses the diagnostic work-up for patients with suspected PMR, as well as the management approaches for newly diagnosed and relapsing disease. […] There is no recognised pathogenic autoantibody associated with PMR. Initial investigations therefore aim to exclude relevant differential diagnoses including: RA (rheumatoid factor and anticyclic citrullinated peptide antibodies [anti-CCP]), connective tissue diseases (antinuclear antibody [ANA]), small-vessel vasculitis (antineutrophil cytoplasmic antibodies [ANCA]), myositis (creatinine kinase [CK]), hypothyroidism (thyroid-stimulating hormone [TSH]), infection (urine microscopy, culture and sensitivity [MCS]), malignancy (calcium).

• #5 Polymyalgia rheumatica – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/diagnosis-treatment/drc-20376545

  A physical exam and lab tests can help your healthcare professional find the cause of your pain and stiffness. The exam may include checking your joints and nervous system, called a neurological exam. During the exam, your healthcare professional might gently move your head and limbs to check their range of motion. […] Your diagnosis might change during treatment. Some people who are diagnosed with polymyalgia rheumatica are later diagnosed with rheumatoid arthritis or giant cell arteritis. […] Tests you might have include: […] Blood tests. Besides checking your complete blood counts, your healthcare professional looks at two lab tests for signs of irritation and swelling, called inflammation. These tests are erythrocyte sedimentation rate, also called sed rate, and C-reactive protein. Not everyone with the condition has high levels of these proteins in their blood, but most do.

• #6

  https://www.nhs.uk/conditions/polymyalgia-rheumatica/diagnosis/

  Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process involving several different tests. […] There’s no specific test for polymyalgia rheumatica, but it’s likely that a series of blood tests will be done. […] If ESR and CRP are normal, its unlikely that polymyalgia rheumatica will be diagnosed. […] Sometimes, ESR may be normal and CRP may be raised, which is more likely to indicate polymyalgia rheumatica. […] Further tests may be needed to help rule out other conditions that cause inflammation. […] After ruling out other possible causes of your symptoms, a checklist can be used to see if your symptoms match those most commonly associated with polymyalgia rheumatica. […] Polymyalgia rheumatica can usually be confidently diagnosed if you meet all of the following criteria: […] blood tests show raised levels of inflammation in your body. […] your symptoms rapidly improve after treatment with steroids.

• #7 Polymyalgia Rheumatica: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/25215-polymyalgia-rheumatica

  Polymyalgia rheumatica diagnosis can be difficult for a healthcare provider to make because the condition is similar to several other medical conditions, such as rheumatoid arthritis, spondyloarthritis, pseudogout, myositis and other connective tissue diseases as well as degenerative joint disease. Your provider will have to rule out these other conditions before making a diagnosis. […] Your provider will ask about your medical history and perform a physical examination. During the exam, they’ll look for the presence of common polymyalgia rheumatica features and those of other possible illnesses. […] There’s no specific blood test for polymyalgia rheumatica, but your provider will order a series of tests that help them find or rule out other conditions. Blood tests may include: Complete blood count (CBC), C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Thyroid-stimulating hormone (TSH), Creatine kinase. […] Your provider may also be able to diagnose polymyalgia rheumatica based on how quickly you respond to corticosteroids (steroids). Most people with the condition feel much better within a few days of starting a low dose of prednisone.

• #8 Polymyalgia rheumatica – an up-to-date review on diagnosis and management

  https://www.oaepublish.com/articles/2574-1209.2023.137

  Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease in those over the age of 50 years. The diagnosis of PMR can be extremely complex, with many mimics and, indeed, marked heterogeneity in disease presentation, arguably necessitating the expertise of a specialist. There is no definitive diagnostic test for polymyalgia rheumatica, making it a diagnostic challenge, often associated with much uncertainty. The typical presenting symptom is sudden onset bilateral shoulder pain and stiffness, a feature which is present in up to 95% of those diagnosed with PMR. Patients also typically experience prolonged early morning stiffness, lasting greater than 45 minutes, with pelvic girdle pain observed in up to 70% of patients. However, not all patients present with this typical constellation of symptoms. Up to 50% of patients may have peripheral musculoskeletal involvement, a feature which most certainly heightens the diagnostic difficulty. Such distal manifestations include peripheral arthritis, most commonly asymmetric, affecting the wrists and knees. Differentiating these patients from those with late-onset rheumatoid arthritis (LORA) can be problematic; however, the combination of bilateral wrist synovitis, and metacarpophalangeal or proximal interphalangeal synovitis is more indicative of a diagnosis of rheumatoid arthritis over PMR. Moreover, the peripheral arthritis typically associated with PMR is non-erosive and very steroid-responsive. Other peripheral manifestations of PMR include carpal tunnel syndrome, in addition to tenosynovitis causing distal swelling and edema, resembling those with RS3PE syndrome. Although these can be a feature of PMR, they can also often herald the diagnosis of other forms of inflammatory arthropathy and thus their presence requires active consideration of an alternative diagnosis. Constitutional symptoms including low-grade fever, fatigue, anorexia, and weight loss can also occur in up to 40% of patients with PMR.

• #9 Polymyalgia rheumatica (PMR) | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/polymyalgia-rheumatica-pmr/

  Theres no specific test to diagnose polymyalgia rheumatica. […] Your doctor will make a diagnosis after listening to you talk about the history of your symptoms and by carrying out a physical examination. […] Youll also have blood tests to check for any inflammation in your body, and to rule out other conditions. […] If youre over 50 and have the following symptoms and signs your GP will probably diagnose polymyalgia rheumatica, and start treatment straight away: new shoulder, neck, hip or thigh pain on both sides of the body, which has been present for at least two weeks, pain and stiff muscles in the shoulders, hips or thighs in the mornings that lasts at least 30 minutes, high levels of inflammation measured by blood tests, no evidence of rheumatoid arthritis, such as swollen joints, or positive blood tests.

• #10 Polymyalgia rheumatica – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/diagnosis-treatment/drc-20376545

  A physical exam and lab tests can help your healthcare professional find the cause of your pain and stiffness. The exam may include checking your joints and nervous system, called a neurological exam. During the exam, your healthcare professional might gently move your head and limbs to check their range of motion. […] Your diagnosis might change during treatment. Some people who are diagnosed with polymyalgia rheumatica are later diagnosed with rheumatoid arthritis or giant cell arteritis. […] Tests you might have include: […] Blood tests. Besides checking your complete blood counts, your healthcare professional looks at two lab tests for signs of irritation and swelling, called inflammation. These tests are erythrocyte sedimentation rate, also called sed rate, and C-reactive protein. Not everyone with the condition has high levels of these proteins in their blood, but most do.

• #11

  https://www.nhs.uk/conditions/polymyalgia-rheumatica/diagnosis/

  Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process involving several different tests. […] There’s no specific test for polymyalgia rheumatica, but it’s likely that a series of blood tests will be done. […] If ESR and CRP are normal, its unlikely that polymyalgia rheumatica will be diagnosed. […] Sometimes, ESR may be normal and CRP may be raised, which is more likely to indicate polymyalgia rheumatica. […] Further tests may be needed to help rule out other conditions that cause inflammation. […] After ruling out other possible causes of your symptoms, a checklist can be used to see if your symptoms match those most commonly associated with polymyalgia rheumatica. […] Polymyalgia rheumatica can usually be confidently diagnosed if you meet all of the following criteria: […] blood tests show raised levels of inflammation in your body. […] your symptoms rapidly improve after treatment with steroids.

• #12 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Implement evidence-based treatment strategies for managing patients with polymyalgia rheumatica. […] Collaborate with an interprofessional healthcare team to optimize comprehensive care for patients with polymyalgia rheumatica. […] Elevated ESR is a common feature in PMR. The majority of authors consider ESR 40 mm/h significant. […] CRP is also typically elevated. […] Normocytic anemia and thrombocytosis can occur. […] Serologic tests, such as an antinuclear antibody (ANA), rheumatoid factor (RF), and anti-citrullinated protein antibodies (Anti-CCP AB), are negative. […] Ultrasound is useful in diagnosing and monitoring treatment by assessing degrees of subacromial/subdeltoid bursitis, long-head biceps tenosynovitis, and glenohumeral synovitis. […] The 2012 ACR/EULAR PMR classification criteria include ultrasound.

• #13 Polymyalgia Rheumatica

  https://mobile.fpnotebook.com/Rheum/Diffuse/PlymylgRhmtc.htm

  Polymyalgia Rheumatica (PMR) is a clinical diagnosis with no absolute definitive test. […] PMR is also a diagnosis of exclusion (other disorders make PMR less likely). […] Diagnosis is based on the British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) Criteria, which include age over 50 years old, bilateral ache in shoulder and/or pelvic girdle, morning stiffness lasting 45 minutes in shoulder and/or pelvic girdle, duration of symptoms for 2 weeks, and an increase in acute phase reactants (i.e. CRP or ESR). […] Acute phase reactant increased (obtain both C-RP and ESR) is necessary for diagnosis. […] C-Reactive Protein (C-RP) has better test sensitivity for Polymyalgia Rheumatica than ESR (elevated in 90% of PMR cases). […] ESR 40 mm/h in 91% of Polymyalgia Rheumatica cases.

• #14 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Implement evidence-based treatment strategies for managing patients with polymyalgia rheumatica. […] Collaborate with an interprofessional healthcare team to optimize comprehensive care for patients with polymyalgia rheumatica. […] Elevated ESR is a common feature in PMR. The majority of authors consider ESR 40 mm/h significant. […] CRP is also typically elevated. […] Normocytic anemia and thrombocytosis can occur. […] Serologic tests, such as an antinuclear antibody (ANA), rheumatoid factor (RF), and anti-citrullinated protein antibodies (Anti-CCP AB), are negative. […] Ultrasound is useful in diagnosing and monitoring treatment by assessing degrees of subacromial/subdeltoid bursitis, long-head biceps tenosynovitis, and glenohumeral synovitis. […] The 2012 ACR/EULAR PMR classification criteria include ultrasound.

• #15

  https://www.nhs.uk/conditions/polymyalgia-rheumatica/diagnosis/

  Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process involving several different tests. […] There’s no specific test for polymyalgia rheumatica, but it’s likely that a series of blood tests will be done. […] If ESR and CRP are normal, its unlikely that polymyalgia rheumatica will be diagnosed. […] Sometimes, ESR may be normal and CRP may be raised, which is more likely to indicate polymyalgia rheumatica. […] Further tests may be needed to help rule out other conditions that cause inflammation. […] After ruling out other possible causes of your symptoms, a checklist can be used to see if your symptoms match those most commonly associated with polymyalgia rheumatica. […] Polymyalgia rheumatica can usually be confidently diagnosed if you meet all of the following criteria: […] blood tests show raised levels of inflammation in your body. […] your symptoms rapidly improve after treatment with steroids.

• #16

  https://journals.lww.com/md-journal/fulltext/2023/09290/diagnostic_difficulties_in_polymyalgia_rheumatica.48.aspx

  The diagnosis of PMR includes some difficulties because it can show heterogeneous clinical findings, an atypical onset, and normal APR values. […] In our study, we found the prevalence of systemic symptoms as 72%. Patients with normal ESR values are expected to have fewer systemic symptoms such as fever, weight loss, and anemia. […] In our study, we identified normal CRP values in 9 patients (16.7%) and in this group, like the results in the group of all patients with normal ESR and CRP values, the duration of symptoms was longer, the rates of systemic symptoms and comorbidities were higher, and there were higher ESR values and more PMR exacerbations. […] It was determined that some PMR patients can have normal ESR and CRP values at the time of their diagnosis. In these patients, imaging methods can show findings that support the diagnosis. Additionally, other APR-related tests such as SAA measurements can be utilized. Compared to patients with elevated ESR and CRP values, patients in this group tend to be younger, have fewer systemic symptoms, and have longer durations of symptoms.

• #17 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Implement evidence-based treatment strategies for managing patients with polymyalgia rheumatica. […] Collaborate with an interprofessional healthcare team to optimize comprehensive care for patients with polymyalgia rheumatica. […] Elevated ESR is a common feature in PMR. The majority of authors consider ESR 40 mm/h significant. […] CRP is also typically elevated. […] Normocytic anemia and thrombocytosis can occur. […] Serologic tests, such as an antinuclear antibody (ANA), rheumatoid factor (RF), and anti-citrullinated protein antibodies (Anti-CCP AB), are negative. […] Ultrasound is useful in diagnosing and monitoring treatment by assessing degrees of subacromial/subdeltoid bursitis, long-head biceps tenosynovitis, and glenohumeral synovitis. […] The 2012 ACR/EULAR PMR classification criteria include ultrasound.

• #18

  https://bpac.org.nz/2023/pmr.aspx

  If the patients history and examination suggests that PMR is likely, the following tests should be requested: CRP (and ESR if CRP is normal), Full blood count (normochromic normocytic anaemia, thrombocytosis and leukocytosis may be present), Serum creatinine and electrolytes, Urinalysis (dipstick), Liver function tests (approximately one-third to half of people with PMR have mildly elevated liver enzymes, particularly alkaline phosphatase). […] There is no gold standard test for the diagnosis of PMR, but elevated acute phase response markers such as CRP and/or ESR should increase suspicion as these are typically raised in a patient with PMR. Normal inflammatory markers although rare (likely under 1%), cannot exclude PMR as a cause of the patients symptoms, and further investigation is required.

• #19

  https://bpac.org.nz/2023/pmr.aspx

  If the patients history and examination suggests that PMR is likely, the following tests should be requested: CRP (and ESR if CRP is normal), Full blood count (normochromic normocytic anaemia, thrombocytosis and leukocytosis may be present), Serum creatinine and electrolytes, Urinalysis (dipstick), Liver function tests (approximately one-third to half of people with PMR have mildly elevated liver enzymes, particularly alkaline phosphatase). […] There is no gold standard test for the diagnosis of PMR, but elevated acute phase response markers such as CRP and/or ESR should increase suspicion as these are typically raised in a patient with PMR. Normal inflammatory markers although rare (likely under 1%), cannot exclude PMR as a cause of the patients symptoms, and further investigation is required.

• #20 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Implement evidence-based treatment strategies for managing patients with polymyalgia rheumatica. […] Collaborate with an interprofessional healthcare team to optimize comprehensive care for patients with polymyalgia rheumatica. […] Elevated ESR is a common feature in PMR. The majority of authors consider ESR 40 mm/h significant. […] CRP is also typically elevated. […] Normocytic anemia and thrombocytosis can occur. […] Serologic tests, such as an antinuclear antibody (ANA), rheumatoid factor (RF), and anti-citrullinated protein antibodies (Anti-CCP AB), are negative. […] Ultrasound is useful in diagnosing and monitoring treatment by assessing degrees of subacromial/subdeltoid bursitis, long-head biceps tenosynovitis, and glenohumeral synovitis. […] The 2012 ACR/EULAR PMR classification criteria include ultrasound.

• #21 Polymyalgia Rheumatica: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/25215-polymyalgia-rheumatica

  Polymyalgia rheumatica diagnosis can be difficult for a healthcare provider to make because the condition is similar to several other medical conditions, such as rheumatoid arthritis, spondyloarthritis, pseudogout, myositis and other connective tissue diseases as well as degenerative joint disease. Your provider will have to rule out these other conditions before making a diagnosis. […] Your provider will ask about your medical history and perform a physical examination. During the exam, they’ll look for the presence of common polymyalgia rheumatica features and those of other possible illnesses. […] There’s no specific blood test for polymyalgia rheumatica, but your provider will order a series of tests that help them find or rule out other conditions. Blood tests may include: Complete blood count (CBC), C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Thyroid-stimulating hormone (TSH), Creatine kinase. […] Your provider may also be able to diagnose polymyalgia rheumatica based on how quickly you respond to corticosteroids (steroids). Most people with the condition feel much better within a few days of starting a low dose of prednisone.

• #22 A new dawn for polymyalgia rheumatica: from diagnosis to emerging treatments | Medicine Today

  https://medicinetoday.com.au/mt/2024/jan-feb/feature-article/new-dawn-polymyalgia-rheumatica-diagnosis-emerging-treatments

  There has been little change in diagnostic and management approaches for polymyalgia rheumatica (PMR) since the 1950s. […] With recent US FDA approval of the first biologic agent for relapsing disease, modern medicine may soon become a reality for patients with PMR. […] Although no specific autoantibody exists for PMR diagnosis, the diagnostic approach should exclude relevant differential diagnoses, such as rheumatoid arthritis, and may be complemented by modern imaging techniques such as ultrasound, MRI and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. […] This article discusses the diagnostic work-up for patients with suspected PMR, as well as the management approaches for newly diagnosed and relapsing disease. […] There is no recognised pathogenic autoantibody associated with PMR. Initial investigations therefore aim to exclude relevant differential diagnoses including: RA (rheumatoid factor and anticyclic citrullinated peptide antibodies [anti-CCP]), connective tissue diseases (antinuclear antibody [ANA]), small-vessel vasculitis (antineutrophil cytoplasmic antibodies [ANCA]), myositis (creatinine kinase [CK]), hypothyroidism (thyroid-stimulating hormone [TSH]), infection (urine microscopy, culture and sensitivity [MCS]), malignancy (calcium).

• #23

  https://bpac.org.nz/2023/pmr.aspx

  If the patients history and examination suggests that PMR is likely, the following tests should be requested: CRP (and ESR if CRP is normal), Full blood count (normochromic normocytic anaemia, thrombocytosis and leukocytosis may be present), Serum creatinine and electrolytes, Urinalysis (dipstick), Liver function tests (approximately one-third to half of people with PMR have mildly elevated liver enzymes, particularly alkaline phosphatase). […] There is no gold standard test for the diagnosis of PMR, but elevated acute phase response markers such as CRP and/or ESR should increase suspicion as these are typically raised in a patient with PMR. Normal inflammatory markers although rare (likely under 1%), cannot exclude PMR as a cause of the patients symptoms, and further investigation is required.

• #24 Polymyalgia rheumatica (PMR) | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/polymyalgia-rheumatica-pmr/

  Theres no specific test to diagnose polymyalgia rheumatica. […] Your doctor will make a diagnosis after listening to you talk about the history of your symptoms and by carrying out a physical examination. […] Youll also have blood tests to check for any inflammation in your body, and to rule out other conditions. […] If youre over 50 and have the following symptoms and signs your GP will probably diagnose polymyalgia rheumatica, and start treatment straight away: new shoulder, neck, hip or thigh pain on both sides of the body, which has been present for at least two weeks, pain and stiff muscles in the shoulders, hips or thighs in the mornings that lasts at least 30 minutes, high levels of inflammation measured by blood tests, no evidence of rheumatoid arthritis, such as swollen joints, or positive blood tests.

• #25

• #26 Polymyalgia rheumatica – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/diagnosis-treatment/drc-20376545

  Imaging tests. An ultrasound can tell whether you have inflammation of the joints and soft tissues and can help in the diagnosis of polymyalgia rheumatica. Some people have an MRI or a PET scan to look for other causes of joint pain. […] To confirm a diagnosis of giant cell arteritis, you may have an ultrasound or a biopsy of an artery in one of your temples. A biopsy involves removing a small sample of the artery for study under a microscope. The biopsy is done with a numbing medicine in the area where the artery is removed.

• #27 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Implement evidence-based treatment strategies for managing patients with polymyalgia rheumatica. […] Collaborate with an interprofessional healthcare team to optimize comprehensive care for patients with polymyalgia rheumatica. […] Elevated ESR is a common feature in PMR. The majority of authors consider ESR 40 mm/h significant. […] CRP is also typically elevated. […] Normocytic anemia and thrombocytosis can occur. […] Serologic tests, such as an antinuclear antibody (ANA), rheumatoid factor (RF), and anti-citrullinated protein antibodies (Anti-CCP AB), are negative. […] Ultrasound is useful in diagnosing and monitoring treatment by assessing degrees of subacromial/subdeltoid bursitis, long-head biceps tenosynovitis, and glenohumeral synovitis. […] The 2012 ACR/EULAR PMR classification criteria include ultrasound.

• #28 Polymyalgia rheumatica: clinical update

  https://www.racgp.org.au/afp/2014/june/polymyalgia-rheumatica

  Polymyalgia rheumatica is a relatively common inflammatory rheumatic disease. There are no validated international guidelines available for the diagnosis and treatment of PMR; however, diagnostic and classification criteria are currently being developed. Diagnosis is made on the basis of a combination of clinical and laboratory findings. Patients typically present with shoulder and hip girdle pain with pronounced stiffness. Inflammatory markers are usually elevated and an ultrasound and MRI of the shoulder and hip can be done to localise inflamed tissues. […] Key differences between the existing BSR criteria and the new EULAR/ACR criteria include the absence of response to steroid treatment (this was not found to have sufficient discriminating value to be included) and the addition of shoulder and hip abnormalities on ultrasound.

• #29 Polymyalgia Rheumatica

  https://mobile.fpnotebook.com/Rheum/Diffuse/PlymylgRhmtc.htm

  False Negative ESR in 6-20% of patients with Polymyalgia Rheumatica. […] Nonspecific lab findings in Polymyalgia Rheumatica (PMR) include moderate anemia, decreased serum albumin, and mildly elevated alkaline phosphatase. […] Imaging such as shoulder ultrasound can show subdeltoid bursitis present in 79% of PMR cases.

• #30 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Patients aged 50 years or older with bilateral shoulder aching and abnormal C-reactive protein concentrations or ESR, plus at least 4 points (without ultrasonography) or 5 points or more (with ultrasonography) from […] Morning stiffness in excess of 45 minutes duration (2 points) […] Absence of rheumatoid factor or anti-citrullinated protein antibodies (2 points) […] Absence of other joint involvement (1 point) […] If ultrasonography is available, at least 1 shoulder with subdeltoid bursitis, biceps tenosynovitis or glenohumeral synovitis (either posterior or axillary), and at least 1 hip with synovitis or trochanteric bursitis (1 point) […] If ultrasonography is available, both shoulders with subdeltoid bursitis, biceps tenosynovitis, or glenohumeral synovitis (1 point). […] PMR and GCA frequently overlap, and 20% of patients with PMR will get diagnosed with GCA later.

• #31 Polymyalgia rheumatica – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/diagnosis-treatment/drc-20376545

  Imaging tests. An ultrasound can tell whether you have inflammation of the joints and soft tissues and can help in the diagnosis of polymyalgia rheumatica. Some people have an MRI or a PET scan to look for other causes of joint pain. […] To confirm a diagnosis of giant cell arteritis, you may have an ultrasound or a biopsy of an artery in one of your temples. A biopsy involves removing a small sample of the artery for study under a microscope. The biopsy is done with a numbing medicine in the area where the artery is removed.

• #32 Polymyalgia Rheumatica (PMR): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/330815-overview

  However, studies do show that interferon-gamma (IFN-) is expressed in nearly 70% of temporal artery biopsy samples from patients with GCA but is not detected in patients with isolated PMR, suggesting IFN- may be crucial to the development of GCA. […] A prospective study of 35 patients with isolated PMR noted vascular (18F) fluorodeoxyglucose positron emission tomography (FDG-PET) imaging at diagnosis in 31% of patients, predominantly at the subclavian arteries, but at a much lower intensity than in GCA patients. […] Increased FDG uptake in the shoulders was seen in 95% of the patients, in the hips in 89%, and in the spinous processes of the cervical and lumbar vertebrae (correlating with interspinous bursitis) of 51% of the patients with isolated PMR. […] A study of circadian variation in PMR found that plasma concentrations of IL-6, IL-8, TNF-, and IL-4 peaked between 4 and 8 am in both untreated patients and controls, although levels of those cytokines were higher throughout the day in patients. […] The peak in cytokines matched the early-morning peak of pain and stiffness in untreated patients.

• #33 A new dawn for polymyalgia rheumatica: from diagnosis to emerging treatments | Medicine Today

  https://medicinetoday.com.au/mt/2024/jan-feb/feature-article/new-dawn-polymyalgia-rheumatica-diagnosis-emerging-treatments

  Although imaging is not needed to diagnose PMR, it can be a helpful addition in certain cases, including in patients presenting with atypical clinical features (e.g. normal CRP level and ESR) or an unacceptably high risk of glucocorticoid-induced adverse events (e.g. poorly controlled diabetes, established osteoporosis), or if there is concern about concomitant large-vessel GCA (e.g. profound constitutional symptoms). […] The most significant breakthrough for PMR in recent years involves the recognition of 18F-fluorodeoxyglucose (18F-FDG) PET/CT as a one-stop shop for diagnosis given its capacity to document distinctive pathology throughout the whole body, assess for concomitant large-vessel GCA and exclude relevant differentials such as infection and malignancy. […] Current guidelines advocate for specialist referral with a view to consider a steroid-sparing agent in patients with PMR who have experienced recurrent relapse, along with those who exhibit an inadequate response to initial prednisolone dosing or who have an unacceptably high risk of glucocorticoid-induced adverse events.

• #34 A new dawn for polymyalgia rheumatica: from diagnosis to emerging treatments | Medicine Today

  https://medicinetoday.com.au/mt/2024/jan-feb/feature-article/new-dawn-polymyalgia-rheumatica-diagnosis-emerging-treatments

  Although imaging is not needed to diagnose PMR, it can be a helpful addition in certain cases, including in patients presenting with atypical clinical features (e.g. normal CRP level and ESR) or an unacceptably high risk of glucocorticoid-induced adverse events (e.g. poorly controlled diabetes, established osteoporosis), or if there is concern about concomitant large-vessel GCA (e.g. profound constitutional symptoms). […] The most significant breakthrough for PMR in recent years involves the recognition of 18F-fluorodeoxyglucose (18F-FDG) PET/CT as a one-stop shop for diagnosis given its capacity to document distinctive pathology throughout the whole body, assess for concomitant large-vessel GCA and exclude relevant differentials such as infection and malignancy. […] Current guidelines advocate for specialist referral with a view to consider a steroid-sparing agent in patients with PMR who have experienced recurrent relapse, along with those who exhibit an inadequate response to initial prednisolone dosing or who have an unacceptably high risk of glucocorticoid-induced adverse events.

• #35 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Patients aged 50 years or older with bilateral shoulder aching and abnormal C-reactive protein concentrations or ESR, plus at least 4 points (without ultrasonography) or 5 points or more (with ultrasonography) from […] Morning stiffness in excess of 45 minutes duration (2 points) […] Absence of rheumatoid factor or anti-citrullinated protein antibodies (2 points) […] Absence of other joint involvement (1 point) […] If ultrasonography is available, at least 1 shoulder with subdeltoid bursitis, biceps tenosynovitis or glenohumeral synovitis (either posterior or axillary), and at least 1 hip with synovitis or trochanteric bursitis (1 point) […] If ultrasonography is available, both shoulders with subdeltoid bursitis, biceps tenosynovitis, or glenohumeral synovitis (1 point). […] PMR and GCA frequently overlap, and 20% of patients with PMR will get diagnosed with GCA later.

• #36 Diagnostic criteria for polymyalgia rheumatica (PMR) – Primary Care Notebook

  https://primarycarenotebook.com/pages/haematology/diagnostic-criteria-for-polymyalgia-rheumatica-pmr

  This diagnostic criteria should be applied in: patients aged 50 years or older presenting with new-onset (12 weeks) bilateral shoulder pain and abnormal acute-phase response (elevated CRP and/or ESR). […] The criteria may only be applied to those patients in whom the symptoms are not better explained by an alternative diagnosis. […] Four clinical and laboratory criteria along with optional ultrasound criteria can be applied to eligible patients to identify patients with PMR suitable for low-dose corticosteroid therapy. […] In the absence of competing diagnoses, a score of 4 or greater (without ultrasound), or 5 or greater (with ultrasound) is indicative of PMR. […] Patients with a score of less than 4 (based on clinical plus laboratory criteria) cannot be considered to have PMR. […] Ultrasound improves the specificity of PMR diagnosis, and shows particularly good performance in differentiating PMR from noninflammatory conditions and thus is a recommended investigation for PMR. […] A score of 4 or more is categorized as polymyalgia rheumatica (PMR) in the algorithm without ultrasound (US) and a score of 5 or more is categorized as PMR in the algorithm with US.

• #37 Diagnostic criteria for polymyalgia rheumatica (PMR) – Primary Care Notebook

  https://primarycarenotebook.com/pages/haematology/diagnostic-criteria-for-polymyalgia-rheumatica-pmr

  This diagnostic criteria should be applied in: patients aged 50 years or older presenting with new-onset (12 weeks) bilateral shoulder pain and abnormal acute-phase response (elevated CRP and/or ESR). […] The criteria may only be applied to those patients in whom the symptoms are not better explained by an alternative diagnosis. […] Four clinical and laboratory criteria along with optional ultrasound criteria can be applied to eligible patients to identify patients with PMR suitable for low-dose corticosteroid therapy. […] In the absence of competing diagnoses, a score of 4 or greater (without ultrasound), or 5 or greater (with ultrasound) is indicative of PMR. […] Patients with a score of less than 4 (based on clinical plus laboratory criteria) cannot be considered to have PMR. […] Ultrasound improves the specificity of PMR diagnosis, and shows particularly good performance in differentiating PMR from noninflammatory conditions and thus is a recommended investigation for PMR. […] A score of 4 or more is categorized as polymyalgia rheumatica (PMR) in the algorithm without ultrasound (US) and a score of 5 or more is categorized as PMR in the algorithm with US.

• #38 Norwegian society of rheumatology recommendations on diagnosis and treatment of patients with Polymyalgia Rheumatica: a narrative review | BMC Rheumatology | Full Text

  https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-024-00422-6

  Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease characterized by subacute onset of proximal muscle pain and stiffness in the neck, shoulders, pelvic girdle and elevated acute phase reactants. […] There is no gold standard for diagnosing PMR and the classification criteria has been defined for use in research. In practice, the diagnosis is based on clinical judgment supported by consistent signs and symptoms of PMR, a rapid response to moderate glucocorticoid (GC) doses and exclusion of mimicking conditions. Recent studies indicate that implementing PMR fast-track clinics may decrease time from symptom onset to diagnosis, and reduce the number of hospital contacts and hospitalization days prior to PMR diagnosis. […] The diagnosis of PMR may be supported by diagnostic imaging and/or validated against current classification criteria. However diagnostic imaging is not obligatory for diagnosis and many patients with PMR will lack relevant findings on imaging. The extent of imaging in such cases will depend on the need to exclude mimicking conditions as the symptoms and laboratory findings of PMR are inherently non-specific.

• #39 Polymyalgia Rheumatica (PMR): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/330815-overview

  Polymyalgia rheumatica (PMR) is a clinical diagnosis based on the complex of presenting symptoms and the exclusion of the other potential diseases (see Presentation and Workup). […] Corticosteroids are considered the treatment of choice, and a rapid response to low-dose corticosteroids is considered pathognomonic. […] Patients who are at risk for relapse, have steroid-related adverse effects, or need prolonged steroid therapy may benefit from the addition of methotrexate or sarilumab. […] Pathologically, GCA and PMR are similar, except that significant vascular involvement does not occur in pure PMR. […] Inflammation is thought to start within the synovium and bursae, with recognition of an unknown antigen by dendritic cells or macrophages. […] Most studies in PMR show that a decrease in the level of circulating IL-6 correlates with remission of clinical symptoms.

• #40 Polymyalgia Rheumatica (PMR) Diagnosis & Treatment | Mount Sinai – New York

  https://www.mountsinai.org/care/rheumatology/services/polymyalgia-rheumatica

  Polymyalgia rheumatica (PMR) is a rheumatic condition that affects older adults, typically men and women over age 60. The diagnosis of this condition is reached with medical history, physical exam and blood work. Once diagnosed initial treatment typically includes prednisone. This condition usually responds promptly with prednisone with a noticeable improvement of symptoms within 24-72 hours of starting the medication. […] Treated PMR may go into remission but often chronic treatment is required.

• #41 Clinical Features, Treatment and Monitoring in Patients With Polymyalgia Rheumatica | Volume 30 – Issue 1 – March 2015 | Archives of Rheumatology

  https://archivesofrheumatology.org/full-text/646

  Objectives: This study aims to evaluate the clinical symptoms and laboratory findings of Turkish patients with polymyalgia rheumatica. […] To the best of our knowledge, there are no specific diagnostic tests for PMR. Diagnosis is based on clinical presentation, evidence of systemic inflammation, and response to corticosteroids. […] A new scoring algorithm was developed based on morning stiffness (45 minutes), hip pain and/or limited range of motion, ultrasound findings absence of rheumatoid factors (RF) and/or anticitrullinated protein antibodies, and absence of peripheral joint pain. […] Initial dose of corticosteroids, use of disease-modifying antirheumatic drugs (DMARDs) therapy, response to corticosteroids, and remission and relapse were detected. […] Good response to initial steroid was observed in 33 patients (80.5%) in the first three weeks of treatment.

• #42 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Patients with PMR should undergo evaluation for features suggestive of GCA at every visit. […] Oral glucocorticoid (GC) therapy is a well-proven treatment. […] The essential points of EULAR-ACR 2015 recommendations for management are summarized as follows: Administer 12.5 to 25 mg daily prednisone equivalent as an initial therapy. […] Taper GCs gradually. […] Taper to an oral dose of 10 mg daily prednisone equivalent within 4 to 8 weeks. […] Once remission is achieved, taper daily oral prednisone by 1 mg every 4 weeks until discontinuation. […] Treat for a minimum of 12 months. […] For relapse, increase oral prednisone to the pre-relapse dose and decrease it gradually (within 4 to 8 weeks) to the dose at which the relapse occurred. […] Close follow-up is recommended. […] It seems prudent to follow up with patients every 3 months until remission and, after that, every 6 months to 1 year to monitor for recurrence. […] Relapses often entail increased ESR and CRP and the return of symptoms.

• #43 Polymyalgia Rheumatica: Symptoms, and Treatment | Doctor

  https://patient.info/doctor/polymyalgia-rheumatica-pro

  Patients should be assessed for response to an initial dose of prednisolone 15 mg daily orally. A patient-reported global improvement of at least 70% within a week of commencing steroids is consistent with PMR, with normalisation of inflammatory markers in four weeks. A lesser response should prompt the search for an alternative condition. […] Specialist referral is recommended for: Atypical clinical presentations: Patient aged under 60 years. […] However, patients with a typical clinical picture and complete sustained response to treatment, and no adverse events, can be managed in primary care.

• #44

  https://bpac.org.nz/2023/pmr.aspx

  Monitoring CRP (or ESR) levels is often helpful when assessing a patients response to prednisone; these should normalise within two to four weeks (however inflammatory marker levels may not always correlate with the patients symptomatic response). […] An inadequate response to prednisone within seven to ten days is uncommon and if this occurs, the diagnosis should be reconsidered. If clinical suspicion for PMR remains, consider trialling a higher prednisone dose after discussing with the local rheumatology service.

• #45

  https://bpac.org.nz/b-quick/pmr.aspx

  A diagnosis of PMR is made clinically based on recognition of a history of characteristic symptoms, with a raised CRP or ESR, exclusion of other conditions which may mimic the history (e.g. rheumatoid arthritis) and a rapid response to oral corticosteroid treatment. […] Request CRP (if normal, request ESR), full blood count, serum creatinine and electrolytes, urinalysis (dipstick) and liver function tests. […] Clinical response to prednisone is assessed based on return to function, e.g. ability to perform movements and tasks that were previously impaired (such as getting out of a chair). Expect improvement to begin within a few days to one week of treatment initiation. […] Reconsider the diagnosis if there is inadequate response to prednisone within seven to ten days. If clinical suspicion for PMR remains, trial a higher prednisone dose after discussing with a rheumatologist. […] Reconsider the diagnosis of PMR if treatment cannot be completely stopped; refer the patient to a rheumatologist if uncertain.

• #46

• #47 Polymyalgia rheumatica: An updated review | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/9/549

  Other laboratory findings consistent with an ongoing inflammatory process and commonly seen in PMR include normochromic anemia, thrombocytosis, and leukocytosis. […] The PMR classification criteria proposed in 2012 by the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) include optional ultrasonographic criteria, allotting a point for either bilateral shoulder pathology or concomitant shoulder and hip findings. […] Use of ultrasonographic criteria increases the specificity of the EULAR/ACR classification system from 81.5% to 91.3%. […] Rapid symptomatic improvement in response to low-dose prednisone ( 15 mg) historically was regarded as diagnostic for PMR. […] However, this response is likely not specific to PMR, as other inflammatory arthritides (eg, rheumatoid arthritis, inflammatory osteoarthritis, crystal arthropathies) may also improve with low-dose prednisone.

• #48 Polymyalgia Rheumatica (PMR) Differential Diagnoses

  https://emedicine.medscape.com/article/330815-differential

  Polymyalgia rheumatica (PMR) and elderly-onset rheumatoid arthritis (EORA) may produce similar symptoms. Wu et al point out the distinctions between the two diseases: In PMR, pain and stiffness tend to occur in the shoulder and pelvic girdle; EORA primarily affects the large joints such as the knee, ankle, and sometimes the shoulder and hip joints. Anticitrullinated protein antibodies (ACPA) are increased in most patients with EORA, but not in patients with PMR. If ACPA is negative, the presence of synovitis on ultrasound or magnetic resonance imaging (MRI) scan can confirm a diagnosis of EORA. Extracapsular changes such as bursitis, peritendinitis, capsulitis, or myofascial lesions, confirmed by ultrasound, MRI scan, or positron emission tomography (PET) scan, suggest a diagnosis of PMR. […] Other problems to be considered in the differential diagnosis of polymyalgia rheumatica include the following: Acute or chronic infection, Infective endocarditis, Bursitis/tendinitis, Cervical spondylosis, Dermatomyositis, Malignancy, Myopathy, Parkinson disease, Remitting seronegative symmetrical synovitis with pitting edema (RS3PE), Shoulder disorders (eg, shoulder synovitis, rotator cuff tendinitis, and subdeltoid bursitis), Calcium pyrophosphate deposition disease, Late-onset ankylosing spondylitis, Vasculitis (eg, giant cell arteritis).

• #49 Polymyalgia rheumatica: clinical update

  https://www.racgp.org.au/afp/2014/june/polymyalgia-rheumatica

  It is crucial to exclude active infection, cancer and other inflammatory conditions. Clinicians must be aware of conditions that mimic PMR. […] Referral to a rheumatologist should be considered if atypical features such as age 60 years, chronic onset, lack of shoulder involvement or inflammatory stiffness, lack of response to steroids or red flags such as prominent systemic symptoms, weight loss or night pain. […] Inflammatory markers (ESR or C reactive protein) are elevated or normal. […] A diagnosis of PMR should be considered in patients aged 50 years who have sub-acute to acute onset of bilateral shoulder pain and stiffness.

• #50 Polymyalgia Rheumatica (PMR) Differential Diagnoses

  https://emedicine.medscape.com/article/330815-differential

  Polymyalgia rheumatica (PMR) and elderly-onset rheumatoid arthritis (EORA) may produce similar symptoms. Wu et al point out the distinctions between the two diseases: In PMR, pain and stiffness tend to occur in the shoulder and pelvic girdle; EORA primarily affects the large joints such as the knee, ankle, and sometimes the shoulder and hip joints. Anticitrullinated protein antibodies (ACPA) are increased in most patients with EORA, but not in patients with PMR. If ACPA is negative, the presence of synovitis on ultrasound or magnetic resonance imaging (MRI) scan can confirm a diagnosis of EORA. Extracapsular changes such as bursitis, peritendinitis, capsulitis, or myofascial lesions, confirmed by ultrasound, MRI scan, or positron emission tomography (PET) scan, suggest a diagnosis of PMR. […] Other problems to be considered in the differential diagnosis of polymyalgia rheumatica include the following: Acute or chronic infection, Infective endocarditis, Bursitis/tendinitis, Cervical spondylosis, Dermatomyositis, Malignancy, Myopathy, Parkinson disease, Remitting seronegative symmetrical synovitis with pitting edema (RS3PE), Shoulder disorders (eg, shoulder synovitis, rotator cuff tendinitis, and subdeltoid bursitis), Calcium pyrophosphate deposition disease, Late-onset ankylosing spondylitis, Vasculitis (eg, giant cell arteritis).

• #51 Polymyalgia Rheumatica: A Severe, Self-Limiting Disease

  https://www.uspharmacist.com/article/polymyalgia-rheumatica-a-severe-self-limiting-disease

  The creatine kinase level is normal; this finding helps differentiate PMR from polymyositis and other primary myopathic disorders. […] Finally, antinuclear antibodies and rheumatoid factor levels are usually normal, and serum interleukin-6 levels are elevated and often closely parallel the inflammatory activity of the disease. […] Radiography of painful joints may rarely show abnormalities such as osteopenia, joint space narrowing, or erosions. Magnetic resonance imaging (MRI) is not necessary for diagnosis, but MRI of the shoulder reveals subacromial and subdeltoid bursitis and glenohumeral joint synovitis in the vast majority of patients. […] TAB may also be warranted in patients with PMR who are receiving low-dose corticosteroids if the clinical response is incomplete or if the ESR remains elevated or rises despite symptom resolution on corticosteroid therapy.

• #52 Polymyalgia Rheumatica (PMR) Differential Diagnoses

  https://emedicine.medscape.com/article/330815-differential

  Polymyalgia rheumatica (PMR) and elderly-onset rheumatoid arthritis (EORA) may produce similar symptoms. Wu et al point out the distinctions between the two diseases: In PMR, pain and stiffness tend to occur in the shoulder and pelvic girdle; EORA primarily affects the large joints such as the knee, ankle, and sometimes the shoulder and hip joints. Anticitrullinated protein antibodies (ACPA) are increased in most patients with EORA, but not in patients with PMR. If ACPA is negative, the presence of synovitis on ultrasound or magnetic resonance imaging (MRI) scan can confirm a diagnosis of EORA. Extracapsular changes such as bursitis, peritendinitis, capsulitis, or myofascial lesions, confirmed by ultrasound, MRI scan, or positron emission tomography (PET) scan, suggest a diagnosis of PMR. […] Other problems to be considered in the differential diagnosis of polymyalgia rheumatica include the following: Acute or chronic infection, Infective endocarditis, Bursitis/tendinitis, Cervical spondylosis, Dermatomyositis, Malignancy, Myopathy, Parkinson disease, Remitting seronegative symmetrical synovitis with pitting edema (RS3PE), Shoulder disorders (eg, shoulder synovitis, rotator cuff tendinitis, and subdeltoid bursitis), Calcium pyrophosphate deposition disease, Late-onset ankylosing spondylitis, Vasculitis (eg, giant cell arteritis).

• #53

  https://bpac.org.nz/2023/pmr.aspx

  If the patients history and examination suggests that PMR is likely, the following tests should be requested: CRP (and ESR if CRP is normal), Full blood count (normochromic normocytic anaemia, thrombocytosis and leukocytosis may be present), Serum creatinine and electrolytes, Urinalysis (dipstick), Liver function tests (approximately one-third to half of people with PMR have mildly elevated liver enzymes, particularly alkaline phosphatase). […] There is no gold standard test for the diagnosis of PMR, but elevated acute phase response markers such as CRP and/or ESR should increase suspicion as these are typically raised in a patient with PMR. Normal inflammatory markers although rare (likely under 1%), cannot exclude PMR as a cause of the patients symptoms, and further investigation is required.

• #54 Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice | British Journal of General Practice

  https://bjgp.org/content/63/610/e361

  Polymyalgia rheumatica (PMR) is a common rheumatological disorder of older patients. The majority of UK patients are diagnosed and managed exclusively in general practice. In primary care, it has been shown that there is wide variation in practice, and established diagnostic criteria are infrequently used. […] This study aims to investigate the diagnostic processes, management, and monitoring of patients with PMR in UK primary care. […] No diagnostic gold standard test exists for PMR, and so clinicians have to rely on existing classification criteria, laboratory findings, and response to treatment, to make a diagnosis, although controversy still exists as to the defining characteristics of the illness. […] Many conditions, including malignancy, can mimic some of the symptoms, signs, and laboratory findings of PMR, and an attempt should be made to exclude these conditions before a diagnosis of PMR is formally made.

• #55 A new dawn for polymyalgia rheumatica: from diagnosis to emerging treatments | Medicine Today

  https://medicinetoday.com.au/mt/2024/jan-feb/feature-article/new-dawn-polymyalgia-rheumatica-diagnosis-emerging-treatments

  There has been little change in diagnostic and management approaches for polymyalgia rheumatica (PMR) since the 1950s. […] With recent US FDA approval of the first biologic agent for relapsing disease, modern medicine may soon become a reality for patients with PMR. […] Although no specific autoantibody exists for PMR diagnosis, the diagnostic approach should exclude relevant differential diagnoses, such as rheumatoid arthritis, and may be complemented by modern imaging techniques such as ultrasound, MRI and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. […] This article discusses the diagnostic work-up for patients with suspected PMR, as well as the management approaches for newly diagnosed and relapsing disease. […] There is no recognised pathogenic autoantibody associated with PMR. Initial investigations therefore aim to exclude relevant differential diagnoses including: RA (rheumatoid factor and anticyclic citrullinated peptide antibodies [anti-CCP]), connective tissue diseases (antinuclear antibody [ANA]), small-vessel vasculitis (antineutrophil cytoplasmic antibodies [ANCA]), myositis (creatinine kinase [CK]), hypothyroidism (thyroid-stimulating hormone [TSH]), infection (urine microscopy, culture and sensitivity [MCS]), malignancy (calcium).

• #56 Polymyalgia Rheumatica: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/25215-polymyalgia-rheumatica

  Polymyalgia rheumatica diagnosis can be difficult for a healthcare provider to make because the condition is similar to several other medical conditions, such as rheumatoid arthritis, spondyloarthritis, pseudogout, myositis and other connective tissue diseases as well as degenerative joint disease. Your provider will have to rule out these other conditions before making a diagnosis. […] Your provider will ask about your medical history and perform a physical examination. During the exam, they’ll look for the presence of common polymyalgia rheumatica features and those of other possible illnesses. […] There’s no specific blood test for polymyalgia rheumatica, but your provider will order a series of tests that help them find or rule out other conditions. Blood tests may include: Complete blood count (CBC), C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Thyroid-stimulating hormone (TSH), Creatine kinase. […] Your provider may also be able to diagnose polymyalgia rheumatica based on how quickly you respond to corticosteroids (steroids). Most people with the condition feel much better within a few days of starting a low dose of prednisone.

• #57 Polymyalgia Rheumatica (PMR) Differential Diagnoses

  https://emedicine.medscape.com/article/330815-differential

  Polymyalgia rheumatica (PMR) and elderly-onset rheumatoid arthritis (EORA) may produce similar symptoms. Wu et al point out the distinctions between the two diseases: In PMR, pain and stiffness tend to occur in the shoulder and pelvic girdle; EORA primarily affects the large joints such as the knee, ankle, and sometimes the shoulder and hip joints. Anticitrullinated protein antibodies (ACPA) are increased in most patients with EORA, but not in patients with PMR. If ACPA is negative, the presence of synovitis on ultrasound or magnetic resonance imaging (MRI) scan can confirm a diagnosis of EORA. Extracapsular changes such as bursitis, peritendinitis, capsulitis, or myofascial lesions, confirmed by ultrasound, MRI scan, or positron emission tomography (PET) scan, suggest a diagnosis of PMR. […] Other problems to be considered in the differential diagnosis of polymyalgia rheumatica include the following: Acute or chronic infection, Infective endocarditis, Bursitis/tendinitis, Cervical spondylosis, Dermatomyositis, Malignancy, Myopathy, Parkinson disease, Remitting seronegative symmetrical synovitis with pitting edema (RS3PE), Shoulder disorders (eg, shoulder synovitis, rotator cuff tendinitis, and subdeltoid bursitis), Calcium pyrophosphate deposition disease, Late-onset ankylosing spondylitis, Vasculitis (eg, giant cell arteritis).

• #58 A new dawn for polymyalgia rheumatica: from diagnosis to emerging treatments | Medicine Today

  https://medicinetoday.com.au/mt/2024/jan-feb/feature-article/new-dawn-polymyalgia-rheumatica-diagnosis-emerging-treatments

  There has been little change in diagnostic and management approaches for polymyalgia rheumatica (PMR) since the 1950s. […] With recent US FDA approval of the first biologic agent for relapsing disease, modern medicine may soon become a reality for patients with PMR. […] Although no specific autoantibody exists for PMR diagnosis, the diagnostic approach should exclude relevant differential diagnoses, such as rheumatoid arthritis, and may be complemented by modern imaging techniques such as ultrasound, MRI and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. […] This article discusses the diagnostic work-up for patients with suspected PMR, as well as the management approaches for newly diagnosed and relapsing disease. […] There is no recognised pathogenic autoantibody associated with PMR. Initial investigations therefore aim to exclude relevant differential diagnoses including: RA (rheumatoid factor and anticyclic citrullinated peptide antibodies [anti-CCP]), connective tissue diseases (antinuclear antibody [ANA]), small-vessel vasculitis (antineutrophil cytoplasmic antibodies [ANCA]), myositis (creatinine kinase [CK]), hypothyroidism (thyroid-stimulating hormone [TSH]), infection (urine microscopy, culture and sensitivity [MCS]), malignancy (calcium).

• #59 Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice | British Journal of General Practice

  https://bjgp.org/content/63/610/e361

  Diagnostic accuracy is clearly essential, as misdiagnosis could result in prolonged inappropriate treatment with corticosteroids or a missed opportunity for early treatment of, for example, malignancy. Current diagnostic pathways advise a low threshold for early specialist referral for diagnostic confirmation in patients with normal or very high inflammatory markers, atypical symptoms, poor response to corticosteroids, or prominent systemic features.

• #60 Polymyalgia rheumatica (PMR) | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/polymyalgia-rheumatica-pmr/

  You may be referred to a rheumatologist if theres any doubt about the diagnosis or if there are complicating factors. […] The presence of inflammation alone wont confirm the diagnosis of polymyalgia rheumatica. […] Inflammation is a feature of many other conditions, including infections and rheumatoid arthritis, so your doctor may do some tests to look for signs of other conditions. […] You may need to have tests such as x-rays or ultrasound scans. […] There are other forms of imaging scans that may occasionally be requested by a rheumatologist to rule out other conditions. […] A condition called anaemia (an-ee-me-a), which is a lack of red blood cells that carry oxygen around the body, is quite common in polymyalgia rheumatica.

• #61 Polymyalgia Rheumatica: Symptoms, and Treatment | Doctor

  https://patient.info/doctor/polymyalgia-rheumatica-pro

  Patients should be assessed for response to an initial dose of prednisolone 15 mg daily orally. A patient-reported global improvement of at least 70% within a week of commencing steroids is consistent with PMR, with normalisation of inflammatory markers in four weeks. A lesser response should prompt the search for an alternative condition. […] Specialist referral is recommended for: Atypical clinical presentations: Patient aged under 60 years. […] However, patients with a typical clinical picture and complete sustained response to treatment, and no adverse events, can be managed in primary care.

• #62 Norwegian society of rheumatology recommendations on diagnosis and treatment of patients with Polymyalgia Rheumatica: a narrative review | BMC Rheumatology | Full Text

  https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-024-00422-6

  We recommend specialist referral in patients with atypical features (e.g., age 50 years, peripheral inflammatory arthritis, constitutional symptoms, low inflammatory parameters), high risk of or already established GC-related adverse reactions, GC-refractory disease, repeated relapses, and/or prolonged treatment. […] Given the diagnostic challenges, collaboration and coordination between general practitioners, rheumatologists and internists and other relevant specialists must be optimized. PMR/GCA-fast track circuits may be important measures to secure prompt and accurate diagnostic work-up for these patients.

• #63 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Patients with PMR should undergo evaluation for features suggestive of GCA at every visit. […] Oral glucocorticoid (GC) therapy is a well-proven treatment. […] The essential points of EULAR-ACR 2015 recommendations for management are summarized as follows: Administer 12.5 to 25 mg daily prednisone equivalent as an initial therapy. […] Taper GCs gradually. […] Taper to an oral dose of 10 mg daily prednisone equivalent within 4 to 8 weeks. […] Once remission is achieved, taper daily oral prednisone by 1 mg every 4 weeks until discontinuation. […] Treat for a minimum of 12 months. […] For relapse, increase oral prednisone to the pre-relapse dose and decrease it gradually (within 4 to 8 weeks) to the dose at which the relapse occurred. […] Close follow-up is recommended. […] It seems prudent to follow up with patients every 3 months until remission and, after that, every 6 months to 1 year to monitor for recurrence. […] Relapses often entail increased ESR and CRP and the return of symptoms.

• #64 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Patients with PMR should undergo evaluation for features suggestive of GCA at every visit. […] Oral glucocorticoid (GC) therapy is a well-proven treatment. […] The essential points of EULAR-ACR 2015 recommendations for management are summarized as follows: Administer 12.5 to 25 mg daily prednisone equivalent as an initial therapy. […] Taper GCs gradually. […] Taper to an oral dose of 10 mg daily prednisone equivalent within 4 to 8 weeks. […] Once remission is achieved, taper daily oral prednisone by 1 mg every 4 weeks until discontinuation. […] Treat for a minimum of 12 months. […] For relapse, increase oral prednisone to the pre-relapse dose and decrease it gradually (within 4 to 8 weeks) to the dose at which the relapse occurred. […] Close follow-up is recommended. […] It seems prudent to follow up with patients every 3 months until remission and, after that, every 6 months to 1 year to monitor for recurrence. […] Relapses often entail increased ESR and CRP and the return of symptoms.

• #65

  https://bpac.org.nz/b-quick/pmr.aspx

  A diagnosis of PMR is made clinically based on recognition of a history of characteristic symptoms, with a raised CRP or ESR, exclusion of other conditions which may mimic the history (e.g. rheumatoid arthritis) and a rapid response to oral corticosteroid treatment. […] Request CRP (if normal, request ESR), full blood count, serum creatinine and electrolytes, urinalysis (dipstick) and liver function tests. […] Clinical response to prednisone is assessed based on return to function, e.g. ability to perform movements and tasks that were previously impaired (such as getting out of a chair). Expect improvement to begin within a few days to one week of treatment initiation. […] Reconsider the diagnosis if there is inadequate response to prednisone within seven to ten days. If clinical suspicion for PMR remains, trial a higher prednisone dose after discussing with a rheumatologist. […] Reconsider the diagnosis of PMR if treatment cannot be completely stopped; refer the patient to a rheumatologist if uncertain.

• #66

  https://bpac.org.nz/2023/pmr.aspx

  Monitoring CRP (or ESR) levels is often helpful when assessing a patients response to prednisone; these should normalise within two to four weeks (however inflammatory marker levels may not always correlate with the patients symptomatic response). […] An inadequate response to prednisone within seven to ten days is uncommon and if this occurs, the diagnosis should be reconsidered. If clinical suspicion for PMR remains, consider trialling a higher prednisone dose after discussing with the local rheumatology service.

• #67 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Patients with PMR should undergo evaluation for features suggestive of GCA at every visit. […] Oral glucocorticoid (GC) therapy is a well-proven treatment. […] The essential points of EULAR-ACR 2015 recommendations for management are summarized as follows: Administer 12.5 to 25 mg daily prednisone equivalent as an initial therapy. […] Taper GCs gradually. […] Taper to an oral dose of 10 mg daily prednisone equivalent within 4 to 8 weeks. […] Once remission is achieved, taper daily oral prednisone by 1 mg every 4 weeks until discontinuation. […] Treat for a minimum of 12 months. […] For relapse, increase oral prednisone to the pre-relapse dose and decrease it gradually (within 4 to 8 weeks) to the dose at which the relapse occurred. […] Close follow-up is recommended. […] It seems prudent to follow up with patients every 3 months until remission and, after that, every 6 months to 1 year to monitor for recurrence. […] Relapses often entail increased ESR and CRP and the return of symptoms.

• #68 Recognition and Management of Polymyalgia Rheumatica and Giant Cell Arteritis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1115/p676.html

  However, in light of strong clinical suspicion, a negative biopsy result does not preclude the diagnosis of giant cell arteritis, and treatment should continue. […] To ensure the best chance of identifying giant cell arteritis, the temporal artery should be biopsied on the patient’s most symptomatic side, with a sample of 1 cm or greater, although more than 2 cm is preferred. […] The mean length of treatment for polymyalgia rheumatica is 1.8 years, although occasionally a more prolonged course of treatment is necessary. […] The mainstay of treatment is corticosteroids with a slow taper, which normally reduces symptoms rapidly. […] Recommendations that address long-term corticosteroid complications are listed. […] All patients should be monitored for long-term complications of high-dose corticosteroid use.

• #69 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  Patients with PMR should undergo evaluation for features suggestive of GCA at every visit. […] Oral glucocorticoid (GC) therapy is a well-proven treatment. […] The essential points of EULAR-ACR 2015 recommendations for management are summarized as follows: Administer 12.5 to 25 mg daily prednisone equivalent as an initial therapy. […] Taper GCs gradually. […] Taper to an oral dose of 10 mg daily prednisone equivalent within 4 to 8 weeks. […] Once remission is achieved, taper daily oral prednisone by 1 mg every 4 weeks until discontinuation. […] Treat for a minimum of 12 months. […] For relapse, increase oral prednisone to the pre-relapse dose and decrease it gradually (within 4 to 8 weeks) to the dose at which the relapse occurred. […] Close follow-up is recommended. […] It seems prudent to follow up with patients every 3 months until remission and, after that, every 6 months to 1 year to monitor for recurrence. […] Relapses often entail increased ESR and CRP and the return of symptoms.

• #70 Polymyalgia Rheumatica – Vasculitis Foundation

  https://vasculitisfoundation.org/education/vasculitis-types/polymyalgia-rheumatica/

  Polymyalgia rheumatica (PMR) is a rare inflammatory disease that affects older adults, causing widespread muscle pain and stiffness, especially around the shoulders and hips. Most people who develop PMR are in their 60s or 70s. PMR is closely linked with giant cell arteritis (GCA), a type of vasculitis characterized by inflammation of the arteries in the head (temples) and of the aorta, resulting in headaches and vision problems. Left untreated, GCA can lead to blindness and stroke. The two diseases can occur at the same time in the same person. Approximately 15 percent to 20 percent of people with PMR will develop GCA, while about half of patients with GCA also have symptoms of PMR. […] There is no single test for diagnosing PMR, so your doctor will consider several factors including a detailed medical history, physical examination, laboratory tests, and less frequently, imaging studies. Your doctor will also look for symptoms and signs of GCA.

• #71 Polymyalgia rheumatica – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/diagnosis-treatment/drc-20376545

  Imaging tests. An ultrasound can tell whether you have inflammation of the joints and soft tissues and can help in the diagnosis of polymyalgia rheumatica. Some people have an MRI or a PET scan to look for other causes of joint pain. […] To confirm a diagnosis of giant cell arteritis, you may have an ultrasound or a biopsy of an artery in one of your temples. A biopsy involves removing a small sample of the artery for study under a microscope. The biopsy is done with a numbing medicine in the area where the artery is removed.

• #72 Recognition and Management of Polymyalgia Rheumatica and Giant Cell Arteritis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1115/p676.html

  However, in light of strong clinical suspicion, a negative biopsy result does not preclude the diagnosis of giant cell arteritis, and treatment should continue. […] To ensure the best chance of identifying giant cell arteritis, the temporal artery should be biopsied on the patient’s most symptomatic side, with a sample of 1 cm or greater, although more than 2 cm is preferred. […] The mean length of treatment for polymyalgia rheumatica is 1.8 years, although occasionally a more prolonged course of treatment is necessary. […] The mainstay of treatment is corticosteroids with a slow taper, which normally reduces symptoms rapidly. […] Recommendations that address long-term corticosteroid complications are listed. […] All patients should be monitored for long-term complications of high-dose corticosteroid use.

• #73 Recognition and Management of Polymyalgia Rheumatica and Giant Cell Arteritis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1115/p676.html

  However, in light of strong clinical suspicion, a negative biopsy result does not preclude the diagnosis of giant cell arteritis, and treatment should continue. […] To ensure the best chance of identifying giant cell arteritis, the temporal artery should be biopsied on the patient’s most symptomatic side, with a sample of 1 cm or greater, although more than 2 cm is preferred. […] The mean length of treatment for polymyalgia rheumatica is 1.8 years, although occasionally a more prolonged course of treatment is necessary. […] The mainstay of treatment is corticosteroids with a slow taper, which normally reduces symptoms rapidly. […] Recommendations that address long-term corticosteroid complications are listed. […] All patients should be monitored for long-term complications of high-dose corticosteroid use.

• #74 Polymyalgia Rheumatica – Vasculitis Foundation

  https://vasculitisfoundation.org/education/vasculitis-types/polymyalgia-rheumatica/

  Part of the diagnosis is ruling out diseases that may cause similar symptoms such as RA, other forms of vasculitis, infections, other muscle diseases or cancer. To make an accurate diagnosis of PMR, the following tests may be ordered: Blood tests: Common tests include a complete blood cell count, erythrocyte sedimentation rate (ESR, or sed rate) and C-reactive protein (CRP) levels, which, when elevated, suggest inflammation. Imaging studies: Ultrasound or magnetic resonance imaging (MRI) may be used to detect inflammation in structures around the joints. Computed tomography angiography (CTA) or magnetic resonance angiography (MRA) may be needed for evaluation of the aorta and its main branches. Biopsy: If your doctor suspects inflammation of the blood vessels such as in GCA, you may undergo a biopsy. This involves surgical removal of a segment of an artery in the temple, which is sent to a laboratory and examined for signs of inflammation.

• #75 Diagnosis of Polymyalgia Rheumatica

  https://www.arthritis-health.com/types/polymyalgia-rheumatica/diagnosis-polymyalgia-rheumatica

  Polymyalgia rheumatica (PMR) can become quite severe if not diagnosed and treated immediately, resulting in severe immobility and disability. Once diagnosed, PMR responds well to medications. […] A doctor may use an ultrasound to provide medical imaging when diagnosing PMR. […] There is no specific test to confirm PMR, however, a doctor can use information from the patients physical examination, laboratory tests, and diagnostic imaging to arrive at an accurate diagnosis. […] A physical examination and medical history can be useful in identifying the signs of PMR. The common findings may include: Severe pain and/or swelling in both shoulders are seen in most cases. […] PMR almost always occurs in people over 50 years of age. […] The common blood tests to help diagnose PMR include: High Erythrocyte sedimentation (ESR) can often be highly elevated and may exceed 100mm/hour in some cases (normal value 30mm/hour).

• #76 Polymyalgia rheumatica | Symptoms, Treatment, Diagnosis | Britannica

  https://www.britannica.com/science/polymyalgia-rheumatica

  polymyalgia rheumatica, joint disease that is fairly common in people over the age of 50, with an average age of onset of about 70. Out of 100,000 people over the age of 50, approximately 700 will exhibit signs of polymyalgia rheumatica. It tends to affect women twice as often as men. The syndrome is characterized by morning stiffness or aching in the neck, shoulders, torso, or hips. […] Diagnosis is complex due to the overlap of symptoms with other diseases, such as rheumatoid arthritis. Along with morning stiffness and aching, the inflammatory process can be detected by analyzing the patients erythrocyte sedimentation rate (ESR). This is the same test used to detect the inflammatory process in temporal arteritis, which is often associated with polymyalgia rheumatica. Fifteen percent of patients with polymyalgia rheumatica will develop temporal arteritis, and 50 percent of patients that have temporal arteritis will develop polymyalgia rheumatica. This association is noteworthy, as one of the primary concerns associated with temporal arteritis is the occurrence of irreversible visual loss.

• #77 POS1383 DIFFERENTIAL DIAGNOSTICS OF POLYMYALGIA RHEUMATICA IN A UNIVERSITY HOSPITAL IN FINLAND | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/81/Suppl_1/1031.1

  Polymyalgia rheumatica (PMR) is an inflammatory disease that causes muscle pain and morning stiffness, especially in the shoulders and hips. Diagnosing PMR can be difficult, as the diagnosis is mainly clinical without a definitive diagnostic test, and many symptoms and findings of PMR may also be present in other conditions. […] In 125 (32.7%) of the 382 patients, the initial diagnosis of PMR changed during further diagnostic evaluation or follow-up. […] Our findings highlight that thorough consideration of differential diagnosis is always essential when diagnosing PMR. Especially in patients with atypical presentation, there is a substantial risk for misdiagnosis.

• #78 Polymyalgia rheumatica – an up-to-date review on diagnosis and management

  https://www.oaepublish.com/articles/2574-1209.2023.137

  Consequently, it is imperative that all patients undergo a thorough evaluation including a careful history and comprehensive physical examination, in order to distinguish PMR from other conditions with similar features, which is arguably best done in specialist rheumatology clinics. A proposed method of optimising early diagnostic accuracy and, indeed, overall patient outcomes is the implementation of fast-track clinics. The use of such fast-track clinics in GCA has been widely reported, with benefits including rapid and accurate diagnosis, reduced risk of permanent visual impairment, in addition to overall increased cost-effectiveness vs. standard care. To date, only two studies have reported on the use of fast-track clinics in PMR, with both demonstrating that providing timely and easily accessible specialist care improves diagnosis and, indeed, patient outcomes. The patients assessed in the fast-track clinics had a faster time to diagnosis of PMR, decreased the total number of days of inpatient hospitalisations, and in one study, had a reduced starting dose of prednisolone vs. those managed by standard care.

• #79

  https://journals.lww.com/ijmr/fulltext/2017/45050/diagnosis_of_polymyalgia_rheumatica_usually_means.4.aspx

  Polymyalgia rheumatica (PMR) is a unique disease of elderly people, traditionally diagnosed based on a clinical picture. A typical case is a combination of severe musculoskeletal symptoms and systemic inflammatory response with spectacular response to corticosteroids treatment. […] The aim of this review article is to discuss about correct diagnosis of PMR. […] There is no universal answer to this question. Although clinical presentation is typical, in some cases, the disease may be surprising. The best strategy is a combination of different approaches (based on clinical picture, classification criteria, exclusions and ex juvantibus diagnosing), together with extensive diagnostics and follow up observation of atypical cases. […] Clinical assessment is most important for PMR diagnosis. There are no specific antibodies (PMR and GCA are T cell-dependent diseases) or additional testing to confirm PMR.

• #80 Norwegian society of rheumatology recommendations on diagnosis and treatment of patients with Polymyalgia Rheumatica: a narrative review | BMC Rheumatology | Full Text

  https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-024-00422-6

  Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease characterized by subacute onset of proximal muscle pain and stiffness in the neck, shoulders, pelvic girdle and elevated acute phase reactants. […] There is no gold standard for diagnosing PMR and the classification criteria has been defined for use in research. In practice, the diagnosis is based on clinical judgment supported by consistent signs and symptoms of PMR, a rapid response to moderate glucocorticoid (GC) doses and exclusion of mimicking conditions. Recent studies indicate that implementing PMR fast-track clinics may decrease time from symptom onset to diagnosis, and reduce the number of hospital contacts and hospitalization days prior to PMR diagnosis. […] The diagnosis of PMR may be supported by diagnostic imaging and/or validated against current classification criteria. However diagnostic imaging is not obligatory for diagnosis and many patients with PMR will lack relevant findings on imaging. The extent of imaging in such cases will depend on the need to exclude mimicking conditions as the symptoms and laboratory findings of PMR are inherently non-specific.

• #81 Norwegian society of rheumatology recommendations on diagnosis and treatment of patients with Polymyalgia Rheumatica: a narrative review | BMC Rheumatology | Full Text

  https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-024-00422-6

  We recommend specialist referral in patients with atypical features (e.g., age 50 years, peripheral inflammatory arthritis, constitutional symptoms, low inflammatory parameters), high risk of or already established GC-related adverse reactions, GC-refractory disease, repeated relapses, and/or prolonged treatment. […] Given the diagnostic challenges, collaboration and coordination between general practitioners, rheumatologists and internists and other relevant specialists must be optimized. PMR/GCA-fast track circuits may be important measures to secure prompt and accurate diagnostic work-up for these patients.

Zobacz więcej