Polymyalgia Rheumatica (PMR) Disease Scoring

 

Patient selection - all of the following:

(1) age >= 50 years

(2) bilateral shoulder aching

(3) abnormal C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR)

 

Parameters:

(1) duration of morning stiffness in minutes

(2) hip findings

(3) serum testing for rheumatoid factor (RF) or anti-citrullinated protein antibody (ACPA)

(4) pain in other joint(s) (not shoulder or hip)

(5) ultrasound findings of shoulder

(6) ultrasound findings of hip

 

Parameter	Finding	Points
duration of morning stiffness	<= 45 minutes	0
	> 45 minutes	2
hip findings	pain OR limited range of motion	1
	neither	0
RF or ACPA	both positive	0
	one or both negative	2
other joint pain (other than shoulder or hip)	none	1
	present	0

 

where:

• The wording for RF or ACPA is ambiguous. In the text on page 949 it is given as "absence of RF and/or ACPA".

 

Ultrasound findings:

(1) in shoulder: subdeltoid bursitis, biceps tendosynovitis, and/or glenohumeral synovitis (either posterior or axillary)

(2) in hip:synovitis and/or trochanteric bursitis

Ultrasound Findings	Points
at least one shoulder with finding AND at least one hip with findings	1
both shoulders with one or more findings	1

 

total score without ultrasound findings =

= SUM(points for first 4 parameters)

 

total score with ultrasound findings =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum score with or without ultrasound findings: 0

• maximum score without ultrasound findings: 6

• maximum score with ultrasound findings: 8

• A score without ultrasound findings >= 4 indicated PMR.

• A score with ultrasound findings >= 5 indicates PMR.