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Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective

Gulsen Ozen1, Nevsun Inanc1, Ali Ugur Unal1

  • 1From the Department of Rheumatology, and Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Marmara University; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Goztepe Medeniyet University; Department of Rheumatology, Fatih Sultan Mehmet Education and Research Hospital; Department of Rheumatology, Faculty of Medicine, Bilim University, Istanbul; Department of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Rheumatology, Faculty of Medicine, Pamukkale University, Denizli; Department of Rheumatology, Sakarya Education and Research Hospital, Sakarya; Department of Rheumatology, Suleyman Demirel University, Isparta; Department of Rheumatology, Faculty of Medicine, Cumhuriyet University, Sivas; Department of Rheumatology, Faculty of Medicine, Erciyes University, Kayseri; Department of Rheumatology, Faculty of Medicine, Trakya University, Edirne; Department of Rheumatology, Selcuklu Faculty of Medicine, Selcuk University, Konya; Department of Rheumatology, Faculty of Medicine, Ege University, Izmir; Department of Rheumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun; Department of Rheumatology, Faculty of Medicine, Sutcu Imam University, Kahramanmaras; Department of Rheumatology, Yunus Emre Government Hospital, Eskisehir, Turkey; Department of Rheumatology, School of Medicine, University of Ottawa, Ottawa, Ontario, Canada.G. Ozen, MD, Department of Rheumatology, Faculty of Medicine, Marmara University; N. Inanc, MD, Professor, Department of Rheumatology, Faculty of Medicine, Marmara University; A.U. Unal, MD, Department of Rheumatology, Faculty of Medicine, Marmara University; S. Bas, MD, Department of Rheumatology, Faculty of Medicine, Marmara University; G. Kimyon, MD, Department of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Professor, Department of Rheumatology, Faculty of Medicine, Gaziantep University; A.M. Onat, MD, Professor, Department of Rhe

The Journal of Rheumatology
|February 3, 2016
PubMed
Abstract

Insights

The new 2012 European League Against Rheumatism/American College of Rheumatology criteria for polymyalgia rheumatica (PMR) show high sensitivity but need improvement in specificity, particularly for distinguishing PMR from seronegative rheumatoid arthritis (RA). Further modifications may enhance diagnostic accuracy.

Area of Science:

  • Rheumatology
  • Clinical Classification
  • Diagnostic Criteria

Background:

  • Polymyalgia rheumatica (PMR) diagnosis can be challenging due to overlapping symptoms with other conditions.
  • Existing diagnostic criteria require evaluation against newer classification systems.

Purpose of the Study:

  • To compare the performance of the 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) PMR classification criteria against previous criteria.
  • To assess the ability of the new criteria to differentiate PMR from mimicking conditions in a multicenter prospective study.

Main Methods:

  • A prospective, multicenter study evaluated patients over 50 with new-onset bilateral shoulder pain and elevated acute-phase reactants (APR).
  • Patients were assessed using both the 2012 EULAR/ACR criteria and previous diagnostic criteria.
  • Discriminating capacity, sensitivity, and specificity were calculated after a 1-year follow-up, with 133 diagnosed with PMR and 142 with non-PMR conditions (including RA).

Main Results:

  • The 2012 EULAR/ACR criteria demonstrated good discriminating capacity (AUC 0.736 for non-PMR, 0.781 for RA) and high sensitivity (89.5%).
  • Specificity was 57.7% against all non-PMR cases and varied significantly against specific conditions (e.g., 20.7% for seronegative RA).
  • Previous criteria, except Bird criteria, generally showed lower sensitivity but higher specificity compared to the new criteria.

Conclusions:

  • The 2012 EULAR/ACR criteria are highly sensitive for diagnosing PMR.
  • However, their specificity is insufficient for differentiating PMR from other inflammatory and noninflammatory shoulder conditions, especially seronegative RA.
  • Enhancements like incorporating imaging or adjusting APR cutoff values may improve the specificity of these criteria.
Keywords:
CLASSIFICATION CRITERIAPOLYMYALGIA RHEUMATICARHEUMATOID ARTHRITIS

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