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):

  1. Age 50 years or older at onset

  2. 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

  3. 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:

  1. Bilateral shoulder pain and/or stiffness

  2. Less than two weeks from onset of symptoms to maximal symptoms

  3. ESR greater than 40 mm per hour

  4. Morning stiffness lasting longer than one hour

  5. Patient older than 65 years

  6. Depression and/or weight loss

  7. Bilateral upper arm tenderness

Criteria Jones and Hazleman (4)

 

All of the following:

  1. Shoulder and pelvic girdle muscle pain without weakness

  2. Morning stiffness

  3. Symptom duration of more than two months unless treated

  4. ESR greater than 30 mm per hour or C-reactive protein level greater than 6 mg per L

  5. No rheumatoid arthritis, inflammatory arthritis or malignant neoplasm

  6. No objective signs of muscle disease

  7. Prompt and dramatic response to systemic corticosteroid therapy

ESR = erythrocyte sedimentation rate.

 

Provisional ACR–EULAR Classification Criteria for Polymyalgia Rheumatica, 2012 (5,6)

 

Mandatory criteria:

  1. Age >/=50 yr
  2. Aching in both shoulders
  3. Abnormal C-reactive protein level, ESR, or both

Additional criteria†

  1. Morning stiffness lasting >45 min (2 points)
  2. Hip pain or reduced range of motion (1 point)
  3. Negative rheumatoid factor or antibodies to cyclic citrullinated peptides (2 points)
  4. Absence of peripheral synovitis (1 point)
  5. Ultrasonographic findings:
    • At least one shoulder with subdeltoid bursitis, biceps tenosynovitis, or glenohumeral synovitis, or at least one hip with synovitis or trochanteric bursitis (1 point)
    • Subdeltoid bursitis, biceps tenosynovitis, or glenohumeral synovitis in both shoulders (1 point)

† According to the provisional ACR–EULAR classification criteria for polymyalgia rheumatica, diagnosis requires that in addition to the mandatory criteria, there must be a score of 4 or more points for additional criteria without ultrasonographic findings (diagnostic sensitivity and specificity, 68% and 78%, respectively) and a score of more than 5 points with ultrasonographic findings (diagnostic sensitivity and specificity, 66% and 81% respectively).

 

 

References:

  1. Brooks RC, McGee SR. Diagnostic dilemmas in polymyalgia rheumatica. Arch Intern Med. 1997 Jan 27;157(2):162-8. [Medline]
  2. 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.
  3. 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]
  4. Jones JG, Hazleman BL. Prognosis and management of polymyalgia rheumatica. Ann Rheum Dis 1981;40:1-5. [Medline]
  5. Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Del Amo M, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Marcus R, Gonter NJ, Maz M, Carter RE, Crowson CS, Matteson EL. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012 Apr;64(4):943-54. [Medline]
  6. Weyand CM, Goronzy JJ. Clinical practice. Giant-cell arteritis and polymyalgia rheumatica. N Engl J Med. 2014 Jul 3;371(1):50-7. [Medline]

Created: Apr 28, 2008