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Published on: May 16, 2025
Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr
C T Pease1, G Haugeberg, B Montague
1Department of Rheumatology, Chapel Allerton Hospital, Chapeltown Road, Leeds LS74SA, UK. colin.pease@leedsth.nhs.uk
Objective:
To describe the pattern of arthropathy and HLA-DRB1 alleles associated with PMR in order to develop a diagnostic algorithm that could help distinguish PMR and RF-negative (RF -ve) late-onset RA (LO-RA) at presentation.
Methods:
This was a prospective study of all patients presenting with PMR or LO-RA over a 10-yr period to one physician. Demographic, clinical and laboratory data were collected at presentation and during a minimum of 5 yrs of follow-up. The accuracy of the initial diagnosis was systematically reviewed.
Results:
One hundred and forty-two patients with LO-RA, 147 with PMR and 42 with PMR + TA were studied. Peripheral synovitis was observed in 23% of the PMR patients. In comparison with RF -ve LO-RA, PMR patients were younger (P < 0.001), myalgia more frequent [100 vs 16% (P < 0.001)] and arthritis of PIP, MCP and wrist were less frequent (P < 0.001). The combination of wrist + MCP/PIP or wrist + PIP + MCP were highly suggestive of RF -ve LO-RA (P < 0.001). HLA-DRB1*0101/0102 and *0401 were significantly increased in PMR patients compared with healthy controls. Plasma viscosity and arthritis in the wrist, in combination with at least one MCP or PIP joint at disease onset, were predictive of whether a non-erosive RF -ve patient would ultimately be diagnosed as having RF -ve LO-RA or PMR (+/-/arthritis).
Conclusion:
Our longitudinal follow-up data were consistent with RF -ve LO-RA being a separate disease entity to PMR despite some phenotypic and immunogenetic similarities at disease onset. A diagnostic algorithm was derived using baseline clinical features to predict the final diagnosis of RF -ve, non-erosive patients.
Insights
This study differentiates polymyalgia rheumatica (PMR) from rheumatoid factor-negative (RF-ve) late-onset rheumatoid arthritis (LO-RA) using clinical and genetic markers. A diagnostic algorithm aids in distinguishing these conditions at presentation for better patient management.
Area of Science:
- Rheumatology
- Immunogenetics
- Clinical Diagnostics
Background:
- Polymyalgia rheumatica (PMR) and rheumatoid factor-negative (RF-ve) late-onset rheumatoid arthritis (LO-RA) share some clinical and immunogenetic similarities.
- Distinguishing between PMR and RF-ve LO-RA at initial presentation is challenging but crucial for appropriate management.
Purpose of the Study:
- To delineate the arthropathy patterns and HLA-DRB1 alleles associated with PMR.
- To develop a diagnostic algorithm for differentiating PMR from RF-ve LO-RA at presentation.
Main Methods:
- A prospective study of patients with PMR or RF-ve LO-RA over 10 years.
- Collection of demographic, clinical, and laboratory data at presentation and during a minimum 5-year follow-up.
- Systematic review of initial diagnostic accuracy.
Main Results:
- Peripheral synovitis occurred in 23% of PMR patients.
- PMR patients were younger, more frequently experienced myalgia, and less frequently had arthritis of PIP, MCP, and wrist joints compared to RF-ve LO-RA.
- Specific HLA-DRB1 alleles (*0101/0102 and *0401) were increased in PMR patients.
- Plasma viscosity and wrist arthritis with MCP/PIP involvement predicted the final diagnosis in non-erosive RF-ve patients.
Conclusions:
- Longitudinal data support RF-ve LO-RA as a distinct entity from PMR.
- A diagnostic algorithm based on baseline clinical features can predict the final diagnosis in RF-ve, non-erosive patients.
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