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Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a
Christian Dejaco1, Christina Duftner, Marco A Cimmino
1Correspondence to Professor Michael Schirmer, Department of Internal Medicine I, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
Objective:
To compare current definitions of remission and relapse in polymyalgia rheumatica (PMR) with items resulting from a Delphi-based expert consensus.
Methods:
Relevant studies including definitions of PMR remission and relapse were identified by literature search in PubMed. The questionnaire used for the Delphi survey included clinical (n=33), laboratory (n=54) and imaging (n=7) parameters retrieved from a literature search. Each item was assessed for importance and availability/practicability, and limits were considered for metric parameters. Consensus was defined by an agreement rate of ≥80%.
Results:
Out of 6031 articles screened, definitions of PMR remission and relapse were available in 18 and 34 studies, respectively. Parameters used to define remission and/or relapse included history and clinical assessment of pain and synovitis, constitutional symptoms, morning stiffness (MS), physician's global assessment, headache, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood count, fibrinogen and/or corticosteroid therapy. In the Delphi exercise a consensus was obtained on the following parameters deemed essential for definitions of remission and relapse: patient's pain assessment, MS, ESR, CRP, shoulder and hip pain on clinical examination, limitation of upper limb elevation, and assessment of corticosteroid dose required to control symptoms.
Conclusions:
Assessment of patient's pain, MS, ESR, CRP, shoulder pain/limitation on clinical examination and corticosteroid dose are considered to be important in current available definitions of PMR remission and relapse and the present expert consensus. The high relevance of clinical assessment of hips was unique to this study and may improve specificity and sensitivity of definitions for remission and relapse in PMR.
Insights
This study compared existing polymyalgia rheumatica (PMR) remission and relapse definitions with expert consensus. Key parameters include patient pain, morning stiffness, inflammatory markers (ESR, CRP), and corticosteroid dose.
Area of Science:
- Rheumatology
- Clinical Medicine
- Epidemiology
Background:
- Current definitions for remission and relapse in polymyalgia rheumatica (PMR) lack standardization.
- Expert consensus is needed to refine these definitions for improved clinical practice and research.
Purpose of the Study:
- To compare existing definitions of PMR remission and relapse with criteria derived from a Delphi-based expert consensus.
- To identify essential parameters for defining PMR remission and relapse.
Main Methods:
- Literature search in PubMed to identify studies with PMR remission/relapse definitions.
- Delphi survey utilizing clinical, laboratory, and imaging parameters.
- Consensus defined by ≥80% agreement on parameter importance and practicality.
Main Results:
- Literature review identified existing parameters including pain, synovitis, constitutional symptoms, morning stiffness (MS), physician assessment, ESR, CRP, and corticosteroid use.
- Delphi consensus identified essential parameters: patient pain assessment, MS, ESR, CRP, shoulder and hip pain on examination, upper limb elevation limitation, and corticosteroid dose.
Conclusions:
- Patient pain assessment, MS, ESR, CRP, shoulder pain/limitation, and corticosteroid dose are crucial for defining PMR remission and relapse.
- Inclusion of hip clinical assessment is a novel finding that may enhance the specificity and sensitivity of PMR remission/relapse definitions.
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