Diagnosis and management practices in polymyalgia rheumatica among Turkish rheumatologists: An online cross-sectional...

To evaluate real-world diagnostic and therapeutic approaches to polymyalgia rheumatica (PMR) among Turkish rheumatologists and compare them with international guideline recommendations.

A cross-sectional online survey was conducted among rheumatologists practicing in Turkiye between September and October 2025. A self-administered 29-item questionnaire was distributed through professional communication networks. The survey was developed with reference to the 2012 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria and international management guidelines. It assessed self-reported diagnostic approaches, screening practices for giant cell arteritis (GCA), treatment strategies, and follow-up and monitoring practices. Data were recorded and analyzed in a de-identified manner using descriptive statistics.

A total of 101 rheumatologists participated in the survey. Diagnostic approaches varied substantially: use of the 2012 EULAR/ACR criteria was reported by 65 (64.4%), referral to the 2010 British Society for Rheumatology/British Health Professionals in Rheumatology (BSR/BHPR) guideline by 10 (9.9%), and primary reliance on clinical judgment by 76 (75.2%). Elevated erythrocyte sedimentation rate and/or C-reactive protein (ESR/CRP) were considered necessary for diagnosis by 92 (91.1%). Use of imaging modalities, including ultrasonography (US), magnetic resonance imaging (MRI), and positron emission tomography (PET), was highly heterogeneous, and routine screening for giant cell arteritis (GCA) was reported by 25 (24.8%). Glucocorticoid (GC) monotherapy was the preferred first-line treatment among 76 participants (75.2%), with most clinicians selecting guideline-recommended starting doses (12.5-25 mg/day) and initiating tapering between weeks 4 and 8. Disease-modifying antirheumatic drugs (DMARDs) were most commonly introduced at first relapse (55, 54.5%). Although osteoporosis risk assessment was reported by 86 (85.1%), the use of dual-energy X-ray absorptiometry (DXA), the Fracture Risk Assessment Tool (FRAX), and referral for exercise programs remained inconsistent.

Although initial GC therapy was generally consistent with guideline recommendations, considerable heterogeneity was observed in diagnostic approaches, imaging use, screening for GCA, and long-term monitoring practices, indicating persistent gaps between guidelines and real-world clinical practice.