Gulsen Ozen1, Nevsun Inanc1, Ali Ugur Unal1, Seda Bas1, Gezmis Kimyon1, Bunyamin Kisacik1, Ahmet Mesut Onat1, Sadiye Murat1, Havva Keskin1, Meryem Can1, Alperen Mengi1, Necati Cakir1, Ayse Balkarli1, Veli Cobankara1, Neslihan Yilmaz1, Ayten Yazici1, Atalay Dogru1, Mehmet Sahin1, Ali Sahin1, Kevser Gok1, Soner Senel1, Omer Nuri Pamuk1, Sema Yilmaz1, Ozun Bayindir1, Kenan Aksu1, Yonca Cagatay1, Lutfi Akyol1, Mehmet Sayarlioglu1, Gozde Yildirim-Cetin1, Sule Yasar-Bilge1, Ilker Yagci1, Sibel Zehra Aydin1, Fatma Alibaz-Oner1, Pamir Atagunduz1, Haner Direskeneli1. 1. From the Department of Rheumatology, and Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Marmara University; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Goztepe Medeniyet University; Department of Rheumatology, Fatih Sultan Mehmet Education and Research Hospital; Department of Rheumatology, Faculty of Medicine, Bilim University, Istanbul; Department of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Rheumatology, Faculty of Medicine, Pamukkale University, Denizli; Department of Rheumatology, Sakarya Education and Research Hospital, Sakarya; Department of Rheumatology, Suleyman Demirel University, Isparta; Department of Rheumatology, Faculty of Medicine, Cumhuriyet University, Sivas; Department of Rheumatology, Faculty of Medicine, Erciyes University, Kayseri; Department of Rheumatology, Faculty of Medicine, Trakya University, Edirne; Department of Rheumatology, Selcuklu Faculty of Medicine, Selcuk University, Konya; Department of Rheumatology, Faculty of Medicine, Ege University, Izmir; Department of Rheumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun; Department of Rheumatology, Faculty of Medicine, Sutcu Imam University, Kahramanmaras; Department of Rheumatology, Yunus Emre Government Hospital, Eskisehir, Turkey; Department of Rheumatology, School of Medicine, University of Ottawa, Ottawa, Ontario, Canada.G. Ozen, MD, Department of Rheumatology, Faculty of Medicine, Marmara University; N. Inanc, MD, Professor, Department of Rheumatology, Faculty of Medicine, Marmara University; A.U. Unal, MD, Department of Rheumatology, Faculty of Medicine, Marmara University; S. Bas, MD, Department of Rheumatology, Faculty of Medicine, Marmara University; G. Kimyon, MD, Department of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Professor, Department of Rheumatology, Faculty of Medicine, Gaziantep University; A.M. Onat, MD, Professor, Department of Rhe
Abstract
OBJECTIVE: To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study. METHODS: Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated. RESULTS: Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls. CONCLUSION: The new 2012 EULAR/ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.
OBJECTIVE: To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study. METHODS:Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated. RESULTS: Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls. CONCLUSION: The new 2012 EULAR/ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.
Authors: Amir Emamifar; Søren Hess; Oke Gerke; Anne Pernille Hermann; Helle Laustrup; Per Syrak Hansen; Peter Thye-Rønn; Niels Marcussen; Frank Svendstrup; Rannveig Gildberg-Mortensen; Jacob Christian Bang; Ziba Ahangarani Farahani; Stavros Chrysidis; Pia Toftegaard; Rikke Asmussen Andreasen; Sebastian le Greves; Hanne Randi Andersen; Rudolf Nezlo Olsen; Inger Marie Jensen Hansen Journal: Medicine (Baltimore) Date: 2017-06 Impact factor: 1.889