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      Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus

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          Abstract

          Objective

          To compare current definitions of remission and relapse in polymyalgia rheumatica (PMR) with items resulting from a Delphi-based expert consensus.

          Methods

          Relevant studies including definitions of PMR remission and relapse were identified by literature search in PubMed. The questionnaire used for the Delphi survey included clinical (n=33), laboratory (n=54) and imaging (n=7) parameters retrieved from a literature search. Each item was assessed for importance and availability/practicability, and limits were considered for metric parameters. Consensus was defined by an agreement rate of ≥80%.

          Results

          Out of 6031 articles screened, definitions of PMR remission and relapse were available in 18 and 34 studies, respectively. Parameters used to define remission and/or relapse included history and clinical assessment of pain and synovitis, constitutional symptoms, morning stiffness (MS), physician's global assessment, headache, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood count, fibrinogen and/or corticosteroid therapy. In the Delphi exercise a consensus was obtained on the following parameters deemed essential for definitions of remission and relapse: patient's pain assessment, MS, ESR, CRP, shoulder and hip pain on clinical examination, limitation of upper limb elevation, and assessment of corticosteroid dose required to control symptoms.

          Conclusions

          Assessment of patient's pain, MS, ESR, CRP, shoulder pain/limitation on clinical examination and corticosteroid dose are considered to be important in current available definitions of PMR remission and relapse and the present expert consensus. The high relevance of clinical assessment of hips was unique to this study and may improve specificity and sensitivity of definitions for remission and relapse in PMR.

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          Most cited references59

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          Polymyalgia rheumatica and giant-cell arteritis.

          Polymyalgia rheumatica and giant-cell arteritis are closely related disorders that affect people of middle age and older. They frequently occur together. Both are syndromes of unknown cause, but genetic and environmental factors might have a role in their pathogenesis. The symptoms of polymyalgia rheumatica seem to be related to synovitis of proximal joints and extra-articular synovial structures. Giant-cell arteritis primarily affects the aorta and its extracranial branches. The clinical findings in giant-cell arteritis are broad, but commonly include visual loss, headache, scalp tenderness, jaw claudication, cerebrovascular accidents, aortic arch syndrome, thoracic aorta aneurysm, and dissection. Glucocorticosteroids are the cornerstone of treatment of both polymyalgia rheumatica and giant-cell arteritis. Some patients have a chronic course and might need glucocorticosteroids for several years. Adverse events of glucocorticosteroids affect more than 50% of patients. Trials of steroid-sparing drugs have yielded conflicting results. A greater understanding of the molecular mechanisms involved in the pathogenesis should provide new targets for therapy.
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            Polymyalgia rheumatica and giant-cell arteritis.

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              • Article: not found

              BSR and BHPR guidelines for the management of polymyalgia rheumatica.

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                Author and article information

                Journal
                Ann Rheum Dis
                annrheumdis
                ard
                Annals of the Rheumatic Diseases
                BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0003-4967
                1468-2060
                March 2011
                19 November 2010
                : 70
                : 3
                : 447-453
                Affiliations
                [1 ]Department of Rheumatology, Medical University Graz, Graz, Austria
                [2 ]Department of Internal Medicine, General Hospital of Kufstein, Kufstein, Austria
                [3 ]Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
                [4 ]Department of Internal Medicine, University of Genova, Genova, Italy
                [5 ]Department of Rheumatology, Southend University Hospital, Essex, UK
                [6 ]Department of Rheumatology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
                [7 ]Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
                [8 ]Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
                Author notes
                Correspondence to Professor Michael Schirmer, Department of Internal Medicine I, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; michael.schirmer@ 123456i-med.ac.at
                Article
                annrheumdis133850
                10.1136/ard.2010.133850
                3033531
                21097803
                dbb0662c-02c6-4038-b95d-0cdce7004563
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                : 2 October 2010
                Categories
                Clinical and Epidemiological Research
                1506
                Extended report
                Custom metadata
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                Immunology
                Immunology

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