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The polymyalgia rheumatica activity score in daily use: proposal for a definition of remission
Burkhard F Leeb1, Bernhard Rintelen, Judith Sautner
1Lower Austrian Center for Rheumatology, State Hospital Stockerau, Stockerau, Austria. leeb.humanis@kav-kost.at
Objective:
To confirm the reliability and applicability of the Polymyalgia Rheumatica Disease Activity Score (PMR-AS), and to establish a threshold for remission.
Methods:
First, 78 patients with PMR (50 women/28 men, mean age 65.97 years) were enrolled in a cross-sectional evaluation. The PMR-AS, patient's satisfaction with disease status (PATSAT; range 1-5), erythrocyte sedimentation rate (ESR; first hour), and a visual analog scale of patients' general health assessment (VAS patient global; range 0-100) were recorded. Subsequently, another 39 PMR patients (24 women/15 men, mean age 68.12 years) were followed longitudinally. Relationships between the PMR-AS, PATSAT, ESR, and VAS patient global were analyzed by the Kruskal-Wallis test, Spearman's rank correlation, and kappa statistics. PMR-AS values in patients with a PATSAT score of 1 and a VAS patient global <10 formed the basis to establish a remission threshold.
Results:
PMR-AS values were significantly related to PATSAT (P < 0.001), VAS patient global (P < 0.001), and ESR (P < 0.01). PATSAT and VAS patient global were reasonably different (kappa = 0.226). The median PMR-AS score in patients with PATSAT score 1 and VAS patient global <10 was 0.7 (range 0-3.3), and the respective 75th percentile was 1.3. To enhance applicability, a range from 0 to 1.5 was proposed to define remission in PMR. The median ESR in these patients was 10 mm/hour (range 3-28), indicating external validity.
Conclusion:
We demonstrated the reliability, validity, and applicability of the PMR-AS in daily routine. Moreover, we proposed a remission threshold (0-1.5) founded on patient-dependent parameters.
Insights
This study validates the Polymyalgia Rheumatica Disease Activity Score (PMR-AS) for clinical use. A remission threshold of 0-1.5 was established using patient-reported outcomes, aiding in PMR management.
Area of Science:
- Rheumatology
- Clinical Assessment
- Disease Activity Measurement
Background:
- Polymyalgia Rheumatica (PMR) requires reliable tools to assess disease activity and remission.
- The Polymyalgia Rheumatica Disease Activity Score (PMR-AS) is a potential measure for PMR assessment.
Purpose of the Study:
- To confirm the reliability and applicability of the PMR-AS.
- To establish a specific threshold for defining remission in PMR patients.
Main Methods:
- Cross-sectional and longitudinal evaluations of 78 and 39 PMR patients, respectively.
- Assessed PMR-AS, patient satisfaction (PATSAT), ESR, and patient global health (VAS).
- Statistical analyses included Kruskal-Wallis, Spearman's correlation, and kappa statistics.
Main Results:
- PMR-AS showed significant correlations with PATSAT, VAS, and ESR.
- A remission threshold was proposed based on PMR-AS values (0-1.5) in patients reporting high satisfaction and good general health.
- Median ESR in remission patients was 10 mm/hour, supporting external validity.
Conclusions:
- The PMR-AS is reliable, valid, and applicable for routine clinical practice in PMR.
- A patient-centered remission threshold (0-1.5) for PMR has been proposed.
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