Performance of the polymyalgia rheumatica activity score for diagnosing disease flares
Article first published online: 31 JAN 2008
Copyright © 2008 by the American College of Rheumatology
Arthritis Care & Research
Volume 59, Issue 2, pages 263–269, 15 February 2008
How to Cite
Binard, A., de Bandt, M., Berthelot, J.-M., Saraux, A. and Inflammatory Joint Disease Working Group of the French Society for Rheumatology (2008), Performance of the polymyalgia rheumatica activity score for diagnosing disease flares. Arthritis & Rheumatism, 59: 263–269. doi: 10.1002/art.23338
- Issue published online: 31 JAN 2008
- Article first published online: 31 JAN 2008
- Manuscript Accepted: 10 SEP 2007
- Manuscript Received: 31 MAY 2007
To evaluate the effectiveness of the polymyalgia rheumatica activity score (PMR-AS) in diagnosing disease flares.
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.
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.
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.