EULAR response criteria for polymyalgia rheumatica: results of an initiative of the European Collaborating Polymyalgia Rheumatica Group (subcommittee of ESCISIT)

Objective: To develop response criteria for polymyalgia rheumatica (PMR) for monitoring treatment and comparing alternative treatments regimens. Methods: 76 patients, mean (SD) age 68.7 (7.7) years, were enrolled. Corticosteroids, and non-steroidal anti-inflammatory drugs (NSAIDs) were the only drugs allowed during the observation period. Erythrocyte sedimentation rate (ESR), C reactive protein (CRP), α2 globulin, serum iron, pain, physician’s global assessment (PGA), morning stiffness (MST), muscle tenderness (MT), myalgia, and the elevation of upper limbs (EUL) were determined regularly. The daily corticosteroid and NSAID doses as the corticosteroid response time were recorded. To ensure evaluation of an adequate number of patients (n = 57) week 24 was chosen for final analysis. Results: ESR, CRP, α2 globulin, pain, PGA, MST, myalgia, MT, and EUL showed significant improvement (p<0.0001) at week 24 compared with week 0. Multiple regression analysis showed that changes of ESR (p = 0.08), CRP (p = 0.41), α2 globulin (p = 0.13), MST (p = 0.1), and MT (p = 0.07) were independent of pain, but myalgia (p<0.001) and EUL (p = 0.003) were pain dependent. Consequently, a core set of PMR response criteria, comprising ESR or CRP, pain, PGA, MST, and EUL was established. Assessment of treatment responses with this core set resulted in 90%, 70%, 50%, and 20% improvement in 31/57 (54%), 46/57 (81%), 51/57 (89%), and 54/57 (95%) of the patients, respectively. Conclusion: These PMR response criteria are a promising tool for better monitoring of disease activity and treatment in PMR. It is proposed that these criteria should be used in clinical trials in the near future to explore alternative treatment options for PMR.

[1]  J. Bijlsma,et al.  [Polymyalgia rheumatica and temporal arteritis]. , 2005, Nederlands tijdschrift voor geneeskunde.

[2]  T. Epperly,et al.  Polymyalgia rheumatica and temporal arthritis. , 2000, American family physician.

[3]  I. Olivieri,et al.  Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: a prospective follow-up study. , 2000, Seminars in arthritis and rheumatism.

[4]  S. Kalke,et al.  A study of the health assessment questionnaire to evaluate functional status in polymyalgia rheumatica. , 2000, Rheumatology.

[5]  J. Gratacós,et al.  Polymyalgia rheumatica with low erythrocyte sedimentation rate at diagnosis. , 2000, The Journal of rheumatology.

[6]  M. Cimmino,et al.  Epidemiology of polymyalgia rheumatica. , 2000, Clinical and experimental rheumatology.

[7]  J. Narváez,et al.  Longterm therapy in polymyalgia rheumatica: effect of coexistent temporal arteritis. , 1999, The Journal of rheumatology.

[8]  W. Ollier,et al.  The spectrum of polymyalgia rheumatica in northwestern Spain: incidence and analysis of variables associated with relapse in a 10 year study. , 1999, The Journal of rheumatology.

[9]  J. Evans,et al.  Corticosteroid requirements in polymyalgia rheumatica. , 1999, Archives of internal medicine.

[10]  M. Fitzsimons,et al.  A 24-year-old man with symptoms and signs of polymyalgia rheumatica. , 1998, The Journal of family practice.

[11]  V. Rodríguez-Valverde,et al.  Polymyalgia rheumatica without significantly increased erythrocyte sedimentation rate. , 1997 .

[12]  S. Gabriel,et al.  Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. , 1997, Arthritis and rheumatism.

[13]  V. Rodríguez-Valverde,et al.  Polymyalgia rheumatica without significantly increased erythrocyte sedimentation rate. A more benign syndrome. , 1997, Archives of internal medicine.

[14]  C. Schrepferman,et al.  The use of methotrexate in polymyalgia rheumatica. , 1996, The Journal of rheumatology.

[15]  F. Salaffi,et al.  Methotrexate in polymyalgia rheumatica: preliminary results of an open, randomized study. , 1996, The Journal of rheumatology.

[16]  V. Kyle,et al.  Erythrocyte sedimentation rate and C reactive protein in the assessment of polymyalgia rheumatica/giant cell arteritis on presentation and during follow up. , 1989, Annals of the rheumatic diseases.

[17]  M. Shingu,et al.  Clinical studies of polymyalgia rheumatica. A proposal of diagnostic criteria. , 1989, Japanese journal of medicine.

[18]  B. Hazleman,et al.  Azathioprine in giant cell arteritis/polymyalgia rheumatica: a double-blind study. , 1986, Annals of the rheumatic diseases.

[19]  A. Wysenbeek,et al.  Masked presentation of giant-cell arteritis. , 1985, Cleveland Clinic quarterly.

[20]  L. A. Healey,et al.  Polymyalgia rheumatica and giant cell arteritis. , 1984, Western Journal of Medicine.

[21]  G. Hunder,et al.  Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. , 1982, Annals of internal medicine.

[22]  P. Wood,et al.  An evaluation of criteria for polymyalgia rheumatica. , 1979, Annals of the rheumatic diseases.