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- Page navigation anchor for RE: Polymyalgia rheumaticaRE: Polymyalgia rheumatica
I read this article with interest. Thank you for drawing attention to this often delayed diagnosis.
Regarding point 3, the authors do not appropriately distinguish between classification and diagnostic criteria when discussing the 2012 EULAR/ACR provisional classification criteria for PMR.
Classification criteria are designed solely to select a homogenous sample of patients for clinical research studies and are not intended to diagnose patients. They are often not sensitive enough for this purpose and fail to capture the heterogeneity intrinsic to rheumatic diseases (Aggarwal et al. 2015).
In fact, the 2012 EULAR/ACR provisional classification criteria to which the authors refer had a sensitivity of just 68% for a score ≥4 in their original cohort (Dasgupta et al. 2012) and the manuscript clearly notes that “these criteria are not meant for diagnostic purposes.”
When diagnosing PMR, rheumatologists take into consideration many factors that are not reflected in the provisional classification criteria, such as patient response to a trial of steroids.
Confusion between classification and diagnostic criteria is common, but it is a crucial distinction. Relying on classification criteria at the bedside results in missed diagnoses.
Competing Interests: None declared.References
- Hans Rosenberg, Samantha Halman, Krishan Yadav. Polymyalgia rheumatica. CMAJ 2021;193:E1770-E1770.
- Aggarwal et al. Distinctions between diagnostic and classification criteria? Arthritis Care Res (Hoboken). 2015;67(7):891.
- Dasgupta et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/ American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2012;71:484–92.
- Page navigation anchor for RE: polymyalgia rheumaticaRE: polymyalgia rheumatica
I had a classical case which responded to prednisone . I had a shorter recurrence several months later. I was one of the percentage of patients who had normal ESR and CRP. No further recurrence in 2 years. I do have finger arthritis.
Patricia ForbesCompeting Interests: None declared.References
- Hans Rosenberg, Samantha Halman, Krishan Yadav. Polymyalgia rheumatica. CMAJ 2021;193:E1770-E1770.