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2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American
Christian Dejaco1, Yogesh P Singh2, Pablo Perel3
1Department of Rheumatology, Medical University Graz, Graz, Austria Department of Rheumatology, Southend University Hospital, Southend, UK.
Abstract:
Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.
Insights
This study presents the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for polymyalgia rheumatica (PMR) management. These guidelines offer an international consensus for clinicians on best practices in PMR patient care.
Area of Science:
- Rheumatology
- Clinical Practice Guidelines
Background:
- Polymyalgia rheumatica (PMR) treatment lacks standardized international recommendations, leading to varied clinical practices.
- Existing therapeutic approaches for PMR are diverse, necessitating a unified guideline.
Purpose of the Study:
- To establish the 2015 European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) recommendations for polymyalgia rheumatica (PMR) management.
- To provide clinicians with an evidence-based consensus on best practices for PMR care.
Main Methods:
- Utilized the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology.
- Developed eight overarching principles and nine specific recommendations based on evidence quality, risk-benefit analysis, and stakeholder preferences.
Main Results:
- Recommendations cover investigations, risk assessment, referral, and treatment strategies including glucocorticoid (GC) dosing and tapering.
- Inclusion of disease-modifying anti-rheumatic drugs (DMARDs), non-steroidal anti-inflammatory drugs (NSAIDs), and non-pharmacological interventions.
- Guidelines address initial GC doses, subsequent tapering regimens, and use of intramuscular GCs.
Conclusions:
- These EULAR/ACR recommendations provide an international consensus for managing polymyalgia rheumatica (PMR).
- The guidelines aim to inform primary, secondary, and tertiary care physicians on optimal PMR patient management.
- Implementation of these recommendations is expected to improve consistency and quality of care for PMR patients.
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