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Patient-reported outcomes in polymyalgia rheumatica
Eric L Matteson1, Hilal Maradit-Kremers, Marco A Cimmino
1Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. matteson.eric@mayo.edu
Objective:
To prospectively evaluate the disease course and the performance of clinical, patient-reported outcome (PRO) and musculoskeletal ultrasound measures in patients with polymyalgia rheumatica (PMR).
Methods:
The study population included 85 patients with new-onset PMR who were initially treated with prednisone equivalent dose of 15 mg daily tapered gradually, and followed for 26 weeks. Data collection included physical examination findings, laboratory measures of acute-phase reactants, and PRO measures. Ultrasound evaluation was performed at baseline and Week 26 to assess for features previously reported to be associated with PMR. Response to corticosteroid treatment was defined as 70% improvement in PMR on visual analog scale (VAS).
Results:
At baseline, 77% had hip pain in addition to shoulder pain and 100% had abnormal C-reactive protein or erythrocyte sedimentation rate. On ultrasound, 84% had shoulder findings and 32% had both shoulder and hip findings. Response to corticosteroid treatment occurred in 73% of patients by Week 4 and was highly correlated with percentage improvement in other VAS measures. Presence of ultrasound findings at baseline predicted response to corticosteroids at 4 weeks. Factor analysis revealed 6 domains that sufficiently represented all the outcome measures: PMR-related pain and physical function, an elevated inflammatory marker, hip pain, global pain, mental function, and morning stiffness.
Conclusion:
PRO measures and inflammatory markers performed well in assessing disease activity in patients with PMR. A minimum set of outcome measures consisting of PRO measures of pain and function and an inflammatory marker should be used in practice and in clinical trials in PMR.
Insights
Patient-reported outcomes and inflammatory markers effectively track polymyalgia rheumatica (PMR) disease activity. A core set of pain, function, and inflammatory measures is recommended for clinical practice and trials.
Area of Science:
- Rheumatology
- Clinical Medicine
- Outcome Measurement
Background:
- Polymyalgia rheumatica (PMR) is a common inflammatory condition affecting older adults.
- Assessing disease activity and treatment response in PMR is crucial for effective management.
- Standardized outcome measures are needed to evaluate disease course and treatment efficacy.
Purpose of the Study:
- To prospectively evaluate the disease course in new-onset polymyalgia rheumatica (PMR).
- To assess the performance of clinical, patient-reported outcome (PRO), and musculoskeletal ultrasound measures in PMR.
- To identify optimal outcome measures for clinical practice and trials in PMR.
Main Methods:
- Prospective study of 85 new-onset PMR patients treated with gradually tapered prednisone.
- Data collection included physical exams, inflammatory markers (CRP/ESR), and PRO measures (VAS).
- Musculoskeletal ultrasound was performed at baseline and 26 weeks; treatment response defined as 70% VAS improvement.
Main Results:
- At baseline, 77% reported hip pain, and 100% had elevated inflammatory markers.
- Ultrasound revealed shoulder findings in 84% and hip/shoulder findings in 32%.
- 73% achieved treatment response by week 4, correlated with other VAS improvements; baseline ultrasound findings predicted response.
Conclusions:
- Patient-reported outcome (PRO) measures and inflammatory markers are effective for assessing PMR disease activity.
- A core set of outcome measures including PROs for pain/function and an inflammatory marker is recommended.
- These measures can enhance clinical practice and improve the design of PMR clinical trials.
