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      The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population

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          Abstract

          Background

          To update community-based prevalence values for Polymyalgia Rheumatic (PMR) and Giant Cell Arteritis (GCA) using case record review supplemented by population survey and subsequent clinical review.

          Methods

          Clinical data were obtained from case records of a large primary care practice in Norfolk, UK and reviewed for diagnoses of GCA and PMR. In addition postal survey was carried out to capture potentially undiagnosed cases within the practice population. Those screening positive for potential diagnoses of GCA and PMR were invited for clinical review. A cumulative prevalence estimate was subsequently calculated on those diagnosed within the GP practice and subsequently on those fulfilling the various published classification criteria sets. The date of the database lock and mail merge was March 2013.

          Results

          Through detailed systematic review of 5,159 GP case records, 21 patients had a recorded diagnosis of GCA and 117 had PMR.No new cases were identified among 2,227 completed questionnaires returned from the population survey of a sample of 4,728. The resulting cumulative prevalence estimate in those aged ≥ 55 years meeting the ACR classification criteria set for GCA was 0.25 % (95 % CI 0.11 to 0.39 %) and for five published criteria sets for PMR ranged from 0.91 to 1.53 % (95 % CI ranges 0.65 %, 1.87 %). The prevalence of both conditions was higher in women than in men and in older age groups.

          Conclusion

          This study provides the first UK prevalence estimate of GCA and PMR in over 30 years and is the first to apply classification criteria sets.

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          Most cited references25

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          2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative

          The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of RF and/or ACPA (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness>45 minutes, elevated CRP and/or ESR and new hip pain. These criteria are not meant for diagnostic purposes.
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            Epidemiology of systemic vasculitis: a ten-year study in the United Kingdom.

            To describe the epidemiology of the primary systemic vasculitides (PSV; Wegener's granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis, polyarteritis nodosa) in a well-defined population over a 10-year period. An inception cohort of patients from the Norwich Health Authority (NHA) who were >15 years of age and had PSV first diagnosed between January 1, 1988 and December 31, 1997 was collected. Incidence rates were adjusted for age and sex to the 1992 population. The prevalence of PSV in this cohort was estimated on December 31, 1997. Patients were classified according to the American College of Rheumatology 1990 vasculitis criteria and the Chapel Hill Consensus definitions. Eighty-two NHA residents fulfilled the inclusion criteria. There were 47 men and 35 women, with a mean age of 62.9 years (median 65.0 years). The overall annual incidence of PSV among NHA residents was 19.8/million (95% confidence interval [95% CI] 15.8-24.6). The point prevalence on December 31, 1997 was 144.5/million (95% CI 110.4-185.3). PSV was more common in males (23.5/million; 95% CI 17.3-31.3) than females (16.4/million; 95% CI 11.4-22.8). The age- and sex-specific incidence showed a clear increase with age, with an overall peak in the 65-74 year age group (60.1/million). In our study population, the annual incidence of PSV is slowly increasing with time and the incidence is greatest in the elderly.
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              The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register.

              This paper provides the first data on the incidence of RA based on a prospective population-based register. All new cases of inflammatory polyarthritis in the Norwich Health Authority are notified by general practitioners to the Norfolk Arthritis Register. The patients are then clinically evaluated by metrologists and blood taken for RF estimation. Cases of RA were defined as all those notified with an onset of symptoms in 1990; who presented by 31 December 1991; and who satisfied the 1987 ARA criteria for RA at the time of presentation. Two hundred and ten patients were notified in the defined time-frame, of whom 104 were classified as having RA. The annual incidence rate was 36/100,000 for women and 14/100,000 for men. RA was rare in men aged under 45 yr. The incidence in men rose steeply with age. The incidence in women rose up to age 45 yr, plateaued to age 75 yr, and fell in the very elderly.
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                Author and article information

                Contributors
                maxyates@doctors.org.uk
                karly.graham@uea.ac.uk
                richard.watts2@mac.com
                a.macgregor@uea.ac.uk
                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                15 July 2016
                15 July 2016
                2016
                : 17
                : 285
                Affiliations
                [ ]Department of Rheumatology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY UK
                [ ]Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, Norfolk NR4 7UQ UK
                Author information
                http://orcid.org/0000-0003-3977-8920
                Article
                1127
                10.1186/s12891-016-1127-3
                4946178
                27421253
                d3cad594-cf35-4b76-83e5-8a7aca653877
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 March 2016
                : 17 June 2016
                Funding
                Funded by: Action Arthritis
                Award ID: R20459
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Orthopedics
                Orthopedics

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