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Validity of the polymyalgia rheumatica activity score in primary care practice
A Binard1, B Lefebvre, M De Bandt
1Rheumatology Unit, Brest Teaching Hospital, Brest, France.
Objective:
To evaluate the validity and reliability of the polymyalgia rheumatica (PMR) activity score (PMR-AS) for relapse diagnosis by general practitioners (GPs) who manage a large proportion of patients with PMR.
Methods:
Seven clinical vignettes of PMR were used, for which 35 rheumatologists previously made a diagnosis of relapse or no relapse with greater than 80% agreement. These vignettes were submitted to 163 GPs, who were asked to assess disease activity using a visual analogue scale (VASph), this being the only physician-dependent component of the PMR-AS. The 1116 available vignette-GP combinations were used to assess differences in VASph assessed by GPs versus rheumatologists. Statistical associations linking a relapse diagnosis by the rheumatologists (the reference standard) to the value of the GP-assessed PMR-AS or its components (GP-assessed VASph, visual analogue scale pain score, C-reactive protein, morning stiffness and elevation of upper limbs) were evaluated.
Results:
No significant differences were found between VASph scores by GPs versus rheumatologists for any of the vignettes. A relapse diagnosis was strongly associated with PMR-AS values of 7 or more (sensitivity 99.4%; specificity 93.3%; agreement 95.9% (95% CI 94.5% to 97.0%) with kappa = 0.92). Of the 590 GP-vignette combinations with PMR-AS values lower than 7, all but three (0.5%) had no relapse diagnosis. Of 510 combinations with PMR-AS values of 7 or more, only 42 (8%) had no flare diagnosis.
Conclusions:
This study supports the validity of the PMR-AS in primary care practice and provides evidence that a good scoring system can be useful to guide clinical and therapeutic decisions.
Insights
The polymyalgia rheumatica (PMR) activity score (PMR-AS) is a valid and reliable tool for general practitioners to diagnose PMR relapses. A PMR-AS of 7 or more accurately indicates a relapse, aiding clinical decisions.
Area of Science:
- Rheumatology
- Primary Care Medicine
- Clinical Diagnostics
Background:
- Polymyalgia rheumatica (PMR) is a common inflammatory condition primarily managed in primary care.
- Accurate and timely diagnosis of PMR relapses is crucial for effective patient management.
- General practitioners (GPs) manage a significant proportion of PMR patients, necessitating reliable diagnostic tools.
Purpose of the Study:
- To assess the validity and reliability of the polymyalgia rheumatica activity score (PMR-AS) for diagnosing PMR relapses by GPs.
- To determine if the PMR-AS can be effectively used in primary care settings.
Main Methods:
- Utilized seven clinical vignettes previously assessed by rheumatologists for relapse diagnosis.
- 163 GPs evaluated disease activity using a visual analogue scale for pain (VASph), a component of the PMR-AS.
- Statistical analysis correlated GP-assessed PMR-AS values and components with rheumatologist-confirmed relapse diagnoses.
Main Results:
- No significant differences were observed in VASph scores between GPs and rheumatologists.
- A PMR-AS of 7 or more demonstrated high sensitivity (99.4%) and specificity (93.3%) for relapse diagnosis, with 95.9% agreement.
- Only 0.5% of cases with PMR-AS below 7 were diagnosed with relapse, and 8% of cases with PMR-AS of 7 or more were not.
Conclusions:
- The PMR-AS is a valid and reliable tool for diagnosing PMR relapses in primary care.
- The PMR-AS can effectively guide clinical and therapeutic decisions for patients with polymyalgia rheumatica.
