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Abstract

Objective

To evaluate the effectiveness of the polymyalgia rheumatica activity score (PMR-AS) in diagnosing disease flares.

Methods

Rheumatologists prospectively included 89 patients with PMR (mean ± SD age 74.6 ± 6.2 years, mean ± SD disease duration 1.6 ± 2.2 years). At each visit, the rheumatologist assessed disease activity using a visual analog scale (VAS) and recorded whether a disease flare was diagnosed and/or the glucocorticoid dose changed. Overall, 137 visits including 49 pairs (allowing intraindividual comparisons) were available; a disease flare was diagnosed at 32 visits. We evaluated statistical associations linking flare diagnosis to the PMR-AS, each of its components (VAS, VAS for pain, C-reactive protein, morning stiffness, and elevation of upper limbs), and changes in these parameters between 2 visits.

Results

Associations with disease flare diagnosis were strongest for PMR-AS scores ≥9.35 (agreement 92%, 95% confidence interval [95% CI] 85.8–95.7%, κ = 0.78; sensitivity 96.6%, 95% CI 80.4–99.8; specificity 90.7%, 95% CI 83.2–95.2) and for ΔPMR-AS scores ≥6.6 (agreement 98%, 95% CI 88.0–99.9%, κ = 0.95; sensitivity 100%, 95% CI 74.7–100; specificity 97.1%, 95% CI 82.9–99.8). Other parameters showed weaker diagnostic performance.

Conclusion

This study supplies new evidence that the PMR-AS is useful for monitoring PMR activity in everyday practice and for managing glucocorticoid tapering. PMR activity changes seem even more relevant than absolute values.