Rapid access strategies for polymyalgia rheumatica: current knowledge

Polymyalgia rheumatica (PMR) is frequently seen in primary care, but diagnosis remains challenging due to the absence of a definitive test and substantial clinical overlap with other conditions. Rapid access strategy (RAS) clinics may facilitate accurate diagnosis and have been widely adopted for giant cell arteritis, but their applicability to PMR has not been established. The aim of this review was to assess current evidence on RAS PMR clinic logistics to inform future clinic development.

A systematic review was conducted using PubMed and EMBASE (inception date to July 2025) with search terms matched with Medical Subject Headings and Boolean operators. Data were extracted from the RAS PMR clinic logistics.

A total of 26 articles were screened, of which 4 studies on RAS PMR clinics were included. All 4 reported the number of individuals referred for rheumatological assessment, used structured referral criteria, and assessments included diagnostic examinations, but varied in their application of supplementary investigations. Between 59% and 73% of the assessments resulted in a diagnosis of PMR. Promotional initiatives, referral processes, and preassessment glucocorticoid initiation varied, and long-term glucocorticoid treatment and follow-up were insufficiently reported. A greater proportion of males than expected from community-based disease incidence was seen.

RAS PMR clinics may potentially improve diagnostic accuracy and reduce inappropriate glucocorticoid initiation, but underreported logistics limit comparability and hinder generalisation. Selection bias was evident across services. No study assessed cost-effectiveness. Future research should focus on defining scalable, evidence-based care pathways before broader adoption can be justified.