The European League against Rheumatism (EULAR) and American College of Rheumatology (ACR) listed criteria for polymyalgia rheumatica (PMR).
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.
Purpose: To evaluate a patient for polymyalgia rheumatica (PMR) using the 2012 EULAR/ACR criteria.
Specialty: Immunology/Rheumatology
Objective: imaging studies, laboratory tests, other testing
ICD-10: M35.3,