Provisional Classification Criteria For Polymyalgia Rheumatica Research Articles

Subclinical giant cell arteritis increases the risk of relapse in polymyalgia rheumatica

ObjectiveThe aim of the present study was to determine the clinical significance of subclinical giant cell arteritis (GCA) in polymyalgia rheumatica (PMR) and ascertain its optimal treatment approach.MethodsPatients with PMR...

Thrombocytosis as a prognostic factor in polymyalgia rheumatica: characteristics determined from cluster analysis.

Background:This study aimed to identify the clinical subgroups of polymyalgia rheumatica (PMR) using cluster analysis and compare the outcomes among the identified subgroups.Methods:We enrolled patients with PMR who were diagnosed at Okayama University Hospital, Japan between 2006 and 2017, met the 2012 European League Against Rheumatism/American College of Rheumatology provisional classification criteria for PMR, and were treated with glucocorticoids. Hierarchical cluster analysis using variables selected by principal component analysis was performed to identify the clusters. Subsequently, the outcomes among the identified clusters were compared in the study. The primary outcome was treatment response at 1 month after commencement of treatment. The secondary outcome was refractory clinical course, which was defined as the requirement of additional treatments or relapse during a 2-year observational period.Results:A total of 61 consecutive patients with PMR were enrolled in the study. Their mean age was 71 years, and 67% were female. Hierarchical cluster analysis revealed three distinct subgroups: cluster 1 (n = 14) was characterized by patients with thrombocytosis (all patients showed a platelet count of >45 × 10⁴/µl), cluster 2 (n = 38), by patients without peripheral arthritis, and cluster 3 (n = 9), by patients with peripheral arthritis. The patients in cluster 1 achieved treatment response less frequently than those in cluster 2 (14% versus 47%, p = 0.030). Refractory cases were more frequent in cluster 1 than in cluster 2; however, no significant difference was noted (71% versus 42%, p = 0.06).Conclusions:Thrombocytosis could predict the clinical course in patients with PMR.

Analysis of the relationship between polymyalgia rheumatica and matrix metalloproteinase-3 levels during the first medical examination and during treatment

In the present study, we assessed the relationship between polymyalgia rheumatica (PMR) and matrix metalloproteinase-3 (MMP-3) levels during the first medical examination and during treatment. We examined 22 patients with PMR in our hospital from 2010 to 2012, in whom the diagnosis was confirmed by the 2012 Provisional Classification Criteria for PMR. The MMP-3 levels were obtained from 19 patients, and the average MMP-3 level was 200.8 ng/mL; this level increased in 15 patients. During the 1 month after treatment initiation, the average dose of prednisolones (PSL) was increased from 2.75 mg/day to 11.3 mg/day, whereas the C-reactive protein level decreased from 6.92 mg/dL to 0.33 mg/dL; however, the average MMP-3 levels increased to 225.1 ng/mL during this period. When comparing the 7 patients in whom PSL withdrawal was achieved within 1 year and the patients in whom PSL withdrawal was difficult, we noted that the MMP-3 levels were higher in the patients in whom PSL withdrawal was difficult, and the MMP-3 level at 3 months after the first medical examination was significantly higher compared to the MMP-3 level during the first medical examination (p = 0.011). Although the MMP-3 level is influenced by PSL use, the MMP-3 levels may be considered to reflect the disease activity of PMR. Thus, MMP-3 levels may be a useful predictive factor for the success of PSL withdrawal in patients with PMR.

Provisional diagnostic criteria for polymyalgia rheumatica: Moving beyond clinical intuition?

In 1964, US Supreme Court Justice Potter Stewart, a master of words, when trying to define hardcore pornography admitted, ‘I could never succeed in intelligibly doing so, but I know it when I see it…’. Polymyalgia rheumatica (PMR) has been in that sense the pornography of rheumatic diseases—a difficult to define syndrome of inflammatory pain and stiffness in older people, but one commonly encountered in practice, and not commonly missed by experienced clinicians. The response to low doses of corticosteroids is often rapid, dramatic, and has been used by many clinicians as a feature that helps define the disease. No single clinical finding or laboratory abnormality is unique to this disorder, and although some aspects of cytokine abnormalities and histopathological findings in this disorder are understood, there is no single identifiable aetiopathogenesis. The rather recent history of PMR is one of many names and definitions, reflecting this uncertainty about the pathology and pathogenesis.1 In this issue of Annals of the Rheumatic Diseases , Dasgupta and colleagues2 report provisional classification criteria for PMR. In a study jointly sponsored by the European League Against Rheumatism and the American College of Rheumatology the authors propose a set of ‘provisional’ classification criteria. These emerged as the result of a multiphase effort in which they initially developed candidate criteria through a systemic literature review, then a consensus process and wider survey. These criteria were then assessed by experts, and those that emerged as most widely agreed upon were reviewed by both rheumatologists and non-rheumatologists in a wider survey generating a number of criteria most widely accepted. They then evaluated the performance of these proposed criteria in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR control patients whose clinical presentation included features that can mimic PMR. They assessed …