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Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study. | LitMetric

Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study.

J Rheumatol

From the Department of Rheumatology, and Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Marmara University; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Goztepe Medeniyet University; Department of Rheumatology, Fatih Sultan Mehmet Education and Research Hospital; Department of Rheumatology, Faculty of Medicine, Bilim University, Istanbul; Department of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Rheumatology, Faculty of Medicine, Pamukkale University, Denizli; Department of Rheumatology, Sakarya Education and Research Hospital, Sakarya; Department of Rheumatology, Suleyman Demirel University, Isparta; Department of Rheumatology, Faculty of Medicine, Cumhuriyet University, Sivas; Department of Rheumatology, Faculty of Medicine, Erciyes University, Kayseri; Department of Rheumatology, Faculty of Medicine, Trakya University, Edirne; Department of Rheumatology, Selcuklu Faculty of Medicine, Selcuk University, Konya; Department of Rheumatology, Faculty of Medicine, Ege University, Izmir; Department of Rheumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun; Department of Rheumatology, Faculty of Medicine, Sutcu Imam University, Kahramanmaras; Department of Rheumatology, Yunus Emre Government Hospital, Eskisehir, Turkey; Department of Rheumatology, School of Medicine, University of Ottawa, Ottawa, Ontario, Canada.G. Ozen, MD, Department of Rheumatology, Faculty of Medicine, Marmara University; N. Inanc, MD, Professor, Department of Rheumatology, Faculty of Medicine, Marmara University; A.U. Unal, MD, Department of Rheumatology, Faculty of Medicine, Marmara University; S. Bas, MD, Department of Rheumatology, Faculty of Medicine, Marmara University; G. Kimyon, MD, Department of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Professor, Department of Rheumatology, Faculty of Medicine, Gaziantep University; A.M. Onat, MD, Professor, Department of Rhe

Published: May 2016

AI Article Synopsis

  • - The study evaluated the effectiveness of the 2012 EULAR/ACR classification criteria for diagnosing polymyalgia rheumatica (PMR) compared to earlier criteria, involving over 270 patients with shoulder pain and elevated inflammatory markers after one year of follow-up.
  • - Results showed that the new criteria had a high sensitivity of 89.5% but a lower specificity of 57.7% when distinguishing PMR from other conditions, particularly in cases of seronegative rheumatoid arthritis (RA).
  • - While the new criteria performed well overall, modifications like imaging and adjusting acute-phase reactant cutoff values are suggested to improve their specificity in differentiating PMR from similar inflammatory conditions.

Article Abstract

Objective: To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study.

Methods: Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated.

Results: Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls.

Conclusion: The new 2012 EULAR/ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.

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Source
http://dx.doi.org/10.3899/jrheum.151103DOI Listing

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