American College of Rheumatology releases first classification criteria for polymyalagia rheumatica

ATLANTA – The American College of Rheumatology has released the first classification criteria for polymyalgia rheumatica – aimed at helping physicians identify patients with this condition, which occurs in persons aged 50 years or older who have recent onset of pain in the shoulders, neck and hips along with other inflammatory symptoms not explained by an alternate diagnosis.

Polymyalgia rheumatica is a relatively common cause of widespread aching and stiffness in older adults. It can be difficult to diagnose because it rarely causes swollen joints or other abnormalities on physical exam. In PMR, the aching is located primarily around the shoulders and hips, and the disease may occur with another rheumatic condition.

Until now, criteria to recognize polymyalgia rheumatica were not well established or tested. The pain and stiffness associated with PMR are common symptoms caused by other illnesses in older people. Additional factors that have contributed to low disease recognition include the lack of standardized tests to confirm the disease, minimal scientific research evaluating therapies, and the absence of genetic markers to identify disease risk.

The new criteria released by the ACR, in collaboration with The European League Against Rheumatism, will improve PMR recognition by defining the important disease features which are useful in classifying patient symptoms caused by this disease. The classification criteria will also provide a structure that will facilitate a better understanding of the disease and its course, and development of new therapies and clinical trials.

"The new criteria were developed by comparing patients with symptoms of PMR caused by a variety of conditions including rheumatoid arthritis and other conditions affecting shoulders and hips and patients with presumed PMR, and following them over a six month period. After six months, the investigators confirmed which patients had PMR, and what the characteristic disease features were, which separated the PMR patients from those with other conditions," says Eric Matteson, MD, MPH; ACR member and chief of rheumatology at the Mayo Clinic College of Medicine.

Dr. Matteson is one of the lead investigators who helped to develop the criteria and adds, "Fulfillment of these criteria will help to ensure that patients with the same disease are being evaluated, which will enhance our ability to study the disease, including performing outcomes studies and clinical trials. Still, there is much to be done to develop better tests for the diagnosis, assessment of disease activity and outcomes of PMR, including further assessment of the new criteria."

PMR is a common inflammatory rheumatic disease of the elderly affecting nearly 711,000 Americans. Under the new criteria, patients 50 years and older can be classified as having PMR if they meet all of the conditions below:

• Shoulder pain on both sides
• Morning stiffness that lasts at least 45 minutes
• High levels of inflammation measured by protein in blood and erythrocyte sedimentation
• Reported new hip pain
• Absence of swelling in the small joints of the hands and feet, and absence of positive blood tests for rheumatoid arthritis

The new classification criteria may also help to evaluate existing treatments for polymyalgia rheumatica. Currently, PMR is treated with low dose corticosteroid such as prednisone. The new criteria will help to assess the benefits of therapies in these patients by ensuring that the patients being evaluated actually all have the same condition.

Editor's note: Classification criteria were created to provide guidance and not for diagnostic purposes. Patients should talk to their rheumatologists to determine best course of treatment.

This study and a related editorial are published in Arthritis & Rheumatism. The articles can be found under the 'Publications' section at www.rheumatology.org or by contacting healthnews@wiley.com.

Article: "2012 Provisional Classification Criteria for Polymyalgia Rheumatica." Bhaskar Dasgupta, Marco A. Cimmino, Hilal Maradit Kremers, Wolfgang A. Schmidt, Michael Schirmer, Carlo Salvarani, Artur Bachta, Christian Dejaco, Christina Duftner, Hanne Slott Jensen, Pierre Dugaut, Gyula Poor, Novak Pal Kaposi, Peter Mandl, Peter V. Balint, Zsuzsa Schmidt, Annamaria Iagnocco, Carlotta Nannini, Fabrizio Cantini, Pierluigi Macchioni, Nicolo Pipitone, Montserrat Del Amo, Georgina Espigol-Frigole, Maria C. Cid, Victor M. Martinez-Taboada, Elisabeth Nordborg, Haner Direskeneli, Sibel Zehra Aydin, Khalid Ahmed, Brian Hazleman, Barbara Silverman, Colin Pease, Richard J. Wakefield, Raashid Luqmani, Andy Abril, Clement J. Michet, Ralph Marcus, Neil J. Gonter, Mehrdad Maz, Rickey E. Carter, Cynthia S. Crowson, and Eric L. Matteson. Arthritis & Rheumatism; Published Online: March 2, 2012 (DOI: 10.1002/art.34356). http://doi.wiley.com/10.1002/art.34356.

Editorial: "Provisional Diagnostic Criteria for Polymyalgia Rheumatica: Moving Beyond Clinical Intuition?" Robert Spiera and Rene. Arthritis & Rheumatism; Published Online: March 2, 2012 (DOI: 10.1002/art.34389). http://doi.wiley.com/10.1002/art.34389.

Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP), a division of the College, and covers all aspects of inflammatory disease. The American College of Rheumatology (www.rheumatology.org) is the professional organization who share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. The journal is published by Wiley-Blackwell on behalf of the ACR. For more information, please visit http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1529-0131.

Headquartered in Atlanta, Ga., the American College of Rheumatology is an international professional medical society that represents more than 8,500 rheumatologists and rheumatology health professionals. Rheumatologists are internists or pediatricians who are qualified by training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Over 50 million Americans — including nearly 300,000 children — suffer from the painful, disabling and sometimes fatal effects of arthritis and rheumatic diseases. Learn more by visiting www.rheumatology.org or follow ACR on Twitter at http://twitter.com/acrheum.

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