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Diagnostic Criteria for Polymyalgia
Rheumatica (PMR)
There is no universally agreed upon
or thoroughly validated set of criteria for the
diagnosis of PMR. In the absence of any pathognomonic
test, we use the following three criteria for the
clinical diagnosis of PMR(1,2):
-
Age 50 years or older at onset
-
Bilateral aching and morning
stiffness (lasting 30 minutes or more) persisting for
at least one month, and involving at least two of the
following three areas: neck or torso, shoulders or
proximal regions of the arms, and hips or proximal
aspects of the thighs
-
ESR (Westergren) elevated to 40
mm/h or more
Some authors add a prompt response of
symptoms to corticosteroids as an additional criterion.
On the other hand, the presence of another disease to
explain the findings excludes the diagnosis.
Criteria Bird/Wood (3)
Three or more of the following, or at
least one of the following plus positive results on
temporal artery biopsy:
-
Bilateral shoulder pain and/or
stiffness
-
Less than two weeks from onset of
symptoms to maximal symptoms
-
ESR greater than 40 mm per hour
-
Morning stiffness lasting longer
than one hour
-
Patient older than 65 years
-
Depression and/or weight loss
-
Bilateral upper arm tenderness
Criteria Jones and Hazleman (4)
All of the following:
-
Shoulder and pelvic girdle muscle
pain without weakness
-
Morning stiffness
-
Symptom duration of more than two
months unless treated
-
ESR greater than 30 mm per hour or
C-reactive protein level greater than 6 mg per L
-
No rheumatoid arthritis,
inflammatory arthritis or malignant neoplasm
-
No objective signs of muscle
disease
-
Prompt and dramatic response to
systemic corticosteroid therapy
ESR = erythrocyte sedimentation rate.
References:
-
Brooks RC, McGee SR. Diagnostic dilemmas in
polymyalgia rheumatica. Arch Intern Med.
1997 Jan 27;157(2):162-8.
[Medline]
-
Hunder, GG. Giant cell arteritis and
polymyalgia rheumatica. In: Textbook of
Rheumatology, 5th ed, Kelly, WN, Harris, ED,
Ruddy, S, Sledge CB (Eds), WB Saunders,
Philadelphia 1996.
-
Bird
HA, Esselinckx W, Dixon AS, Mowat AG, Wood
PH. An evaluation of criteria for
polymyalgia rheumatica. Ann Rheum Dis
1979;38:434-9.
[Medline]
-
Jones JG, Hazleman BL. Prognosis and
management of polymyalgia rheumatica. Ann
Rheum Dis 1981;40:1-5.
[Medline]
Created: Apr 28, 2008
Last Modified:
04/27/2008 |
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