{"id":2525,"date":"2009-03-05T18:27:35","date_gmt":"2009-03-05T18:27:35","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/reupmr\/"},"modified":"2025-05-14T19:10:53","modified_gmt":"2025-05-14T19:10:53","slug":"reupmr","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/reupmr\/","title":{"rendered":"Diagnostic Criteria for Polymyalgia Rheumatica (PMR)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p><\/p>\n<div class=\"Section1\">\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">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):<\/p>\n<p><!--more--><\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Age 50 years or older at onset<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">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<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">ESR (Westergren) elevated to 40 mm\/h or more<\/p>\n<\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">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.<\/p>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong>Criteria Bird\/Wood (3)<\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong>\u00a0<\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Three or more of the following, or at least one of the following plus positive results on temporal artery biopsy:<\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Bilateral shoulder pain and\/or stiffness<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Less than two weeks from onset of symptoms to maximal symptoms<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">ESR greater than 40 mm per hour<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Morning stiffness lasting longer than one hour<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Patient older than 65 years<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Depression and\/or weight loss<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Bilateral upper arm tenderness<\/p>\n<\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong>Criteria Jones and Hazleman (4)<\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong>\u00a0<\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">All of the following:<\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Shoulder and pelvic girdle muscle pain without weakness<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Morning stiffness<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Symptom duration of more than two months unless treated<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">ESR greater than 30 mm per hour or C-reactive protein level greater than 6 mg per L<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">No rheumatoid arthritis, inflammatory arthritis or malignant neoplasm<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">No objective signs of muscle disease<\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Prompt and dramatic response to systemic corticosteroid therapy<\/p>\n<\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">ESR = erythrocyte sedimentation rate.<\/p>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong>Provisional ACR\u2013EULAR Classification Criteria for Polymyalgia Rheumatica, 2012 (5,6)<\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong>\u00a0<\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Mandatory criteria:<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Age &gt;\/=50 yr<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Aching in both shoulders<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Abnormal C-reactive protein level, ESR, or both<\/span><\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Additional criteria\u2020<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Morning stiffness lasting &gt;45 min (2 points)<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Hip pain or reduced range of motion (1 point)<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Negative rheumatoid factor or antibodies to cyclic citrullinated peptides <\/span><span style=\"line-height: 1.3em;\">(2 points)<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Absence of peripheral synovitis (1 point)<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Ultrasonographic findings:<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"line-height: 1.3em;\">At least one shoulder with subdeltoid bursitis, biceps tenosynovitis, <\/span><span style=\"line-height: 1.3em;\">or glenohumeral synovitis, or at least one hip with synovitis or trochanteric bursitis (1 point)<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Subdeltoid bursitis, biceps tenosynovitis, or glenohumeral synovitis <\/span><span style=\"line-height: 1.3em;\">in both shoulders (1 point)<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"line-height: 1.3em;\">\u2020 According to the provisional ACR\u2013EULAR classification criteria for polymyalgia rheumatica, diagnosis requires that in addition to the mandatory criteria, <\/span><span style=\"line-height: 1.3em;\">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 <\/span><span style=\"line-height: 1.3em;\">(diagnostic sensitivity and specificity, 66% and 81% respectively).<\/span><\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\"><strong>References:<\/strong><\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Brooks RC, McGee SR. Diagnostic dilemmas in polymyalgia rheumatica. Arch Intern Med. 1997 Jan 27;157(2):162-8. <\/span><span style=\"line-height: 1.3em;\"> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/9009973\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">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.<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Bird HA, Esselinckx W, Dixon AS, Mowat AG, Wood PH. An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis 1979;38:434-9. <\/span><span style=\"line-height: 1.3em;\"> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/518143\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Jones JG, Hazleman BL. Prognosis and management of polymyalgia rheumatica. Ann Rheum Dis 1981;40:1-5. <\/span><span style=\"line-height: 1.3em;\"> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/7469518\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Po\u00f3r G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Del Amo M, Esp\u00edgol-Frigol\u00e9 G, Cid MC, Mart\u00ednez-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. <\/span><span style=\"line-height: 1.3em;\">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. [<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22389040\/\" target=\"_blank\" rel=\"noopener noreferrer\">Medline]<\/a><\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Weyand CM, Goronzy JJ. Clinical practice. Giant-cell arteritis and polymyalgia rheumatica. N Engl J Med. 2014 Jul 3;371(1):50-7. <\/span><a style=\"line-height: 1.3em;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24988557\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created: Apr 28, 2008<br \/>\nUpdate: Dec 01, 2014<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[45],"tags":[16,15,14,13,1607,1606,1605,1604,1603,1070],"class_list":["post-2525","post","type-post","status-publish","format-standard","hentry","category-rheumatology","tag-criteria","tag-criterios","tag-diagnostic","tag-diagnostico","tag-pmr","tag-polimialgia","tag-polymyalgia","tag-reumatica","tag-rheumatica","tag-rheumatology"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2525","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2525"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2525\/revisions"}],"predecessor-version":[{"id":9458,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2525\/revisions\/9458"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2525"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2525"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2525"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}