Developing classification criteria for polymyalgia rheumatica: Comparison of views from an expert panel and wider survey

Bhaskar Dasgupta, Carlo Salvarani, Michael Schirmer, Cynthia Crowson, Hilal D Maradit Kremers, Andrew Hutchings, Eric Lawrence Matteson, K. Barraclough, H. Bird, K. Calamia, F. Cantini, M. Cid, M. Cimmino, C. Dejaco, W. Docken, L. Guillevin, P. Duhaut, B. Hazelman, G. Hoffman, G. HunderM. A. Gonzalez-Gay, C. Langford, B. Leeb, V. Martinez-Taboada, P. A. Merkel, Clement Michet, E. Nordborg, C. Pease, N. Pipitone, W. Schmidt, A. Wagner, P. Bacon

Research output: Contribution to journalArticle

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Abstract

Objective. This report summarizes the findings from a consensus process to identify potential classification criteria for polymyalgia rheumatica (PMR). Methods. A 3-stage hybrid consensus approach was used to develop potential PMR classification criteria. The first stage consisted of a facilitated meeting of 27 international experts who anonymously rated the importance of 68 potential criteria. The second stage involved a meeting of the experts, who were provided with the results of the first round of ratings and were then asked to re-rate the criteria. In the third stage, the wider acceptance of the 43 criteria that received > 50% support at round 2 was evaluated using an extended mailed survey of 111 rheumatologists and 53 nonrheumatologists in the United States, Canada, and Northern and Western Europe. Results. A total of 68 and 50 criteria were identified and rated in round 1 and round 2, respectively. In round 2, 43 of the 50 items achieved at least 50% support, including 10 core criteria achieving 100% support. In round 3, over 70% of survey respondents agreed on the importance of 7 core criteria. These were age ≥ 50 years, duration ≥ 2 weeks, bilateral shoulder and/or pelvic girdle aching, duration of morning stiffness > 45 min, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and rapid steroid response (> 75% global response within 1 wk to prednisolone/prednisone 15-20 mg daily). Among physical signs, more than 70% of survey respondents agreed on the importance of assessing pain and limitation of shoulder (84%) and/or hip (76%) on motion, but agreement was low for peripheral signs like carpal tunnel, tenosynovitis, and peripheral arthritis. Conclusion. There are differences in opinion as to what PMR is and how it should be treated. These findings make it important to develop classification criteria for PMR. The next step is to perform an international prospective study to evaluate the utility of candidate classification criteria for PMR in patients presenting with the polymyalgic syndrome.

Original languageEnglish (US)
Pages (from-to)270-277
Number of pages8
JournalJournal of Rheumatology
Volume35
Issue number2
StatePublished - Feb 2008

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Polymyalgia Rheumatica
Tenosynovitis
Shoulder Pain
Blood Sedimentation
Prednisone
Prednisolone
Wrist
C-Reactive Protein
Arthritis
Canada
Hip
Consensus
Steroids
Surveys and Questionnaires
Prospective Studies

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

Developing classification criteria for polymyalgia rheumatica : Comparison of views from an expert panel and wider survey. / Dasgupta, Bhaskar; Salvarani, Carlo; Schirmer, Michael; Crowson, Cynthia; Maradit Kremers, Hilal D; Hutchings, Andrew; Matteson, Eric Lawrence; Barraclough, K.; Bird, H.; Calamia, K.; Cantini, F.; Cid, M.; Cimmino, M.; Dejaco, C.; Docken, W.; Guillevin, L.; Duhaut, P.; Hazelman, B.; Hoffman, G.; Hunder, G.; Gonzalez-Gay, M. A.; Langford, C.; Leeb, B.; Martinez-Taboada, V.; Merkel, P. A.; Michet, Clement; Nordborg, E.; Pease, C.; Pipitone, N.; Schmidt, W.; Wagner, A.; Bacon, P.

In: Journal of Rheumatology, Vol. 35, No. 2, 02.2008, p. 270-277.

Research output: Contribution to journalArticle

Dasgupta, B, Salvarani, C, Schirmer, M, Crowson, C, Maradit Kremers, HD, Hutchings, A, Matteson, EL, Barraclough, K, Bird, H, Calamia, K, Cantini, F, Cid, M, Cimmino, M, Dejaco, C, Docken, W, Guillevin, L, Duhaut, P, Hazelman, B, Hoffman, G, Hunder, G, Gonzalez-Gay, MA, Langford, C, Leeb, B, Martinez-Taboada, V, Merkel, PA, Michet, C, Nordborg, E, Pease, C, Pipitone, N, Schmidt, W, Wagner, A & Bacon, P 2008, 'Developing classification criteria for polymyalgia rheumatica: Comparison of views from an expert panel and wider survey', Journal of Rheumatology, vol. 35, no. 2, pp. 270-277.
Dasgupta, Bhaskar ; Salvarani, Carlo ; Schirmer, Michael ; Crowson, Cynthia ; Maradit Kremers, Hilal D ; Hutchings, Andrew ; Matteson, Eric Lawrence ; Barraclough, K. ; Bird, H. ; Calamia, K. ; Cantini, F. ; Cid, M. ; Cimmino, M. ; Dejaco, C. ; Docken, W. ; Guillevin, L. ; Duhaut, P. ; Hazelman, B. ; Hoffman, G. ; Hunder, G. ; Gonzalez-Gay, M. A. ; Langford, C. ; Leeb, B. ; Martinez-Taboada, V. ; Merkel, P. A. ; Michet, Clement ; Nordborg, E. ; Pease, C. ; Pipitone, N. ; Schmidt, W. ; Wagner, A. ; Bacon, P. / Developing classification criteria for polymyalgia rheumatica : Comparison of views from an expert panel and wider survey. In: Journal of Rheumatology. 2008 ; Vol. 35, No. 2. pp. 270-277.
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abstract = "Objective. This report summarizes the findings from a consensus process to identify potential classification criteria for polymyalgia rheumatica (PMR). Methods. A 3-stage hybrid consensus approach was used to develop potential PMR classification criteria. The first stage consisted of a facilitated meeting of 27 international experts who anonymously rated the importance of 68 potential criteria. The second stage involved a meeting of the experts, who were provided with the results of the first round of ratings and were then asked to re-rate the criteria. In the third stage, the wider acceptance of the 43 criteria that received > 50{\%} support at round 2 was evaluated using an extended mailed survey of 111 rheumatologists and 53 nonrheumatologists in the United States, Canada, and Northern and Western Europe. Results. A total of 68 and 50 criteria were identified and rated in round 1 and round 2, respectively. In round 2, 43 of the 50 items achieved at least 50{\%} support, including 10 core criteria achieving 100{\%} support. In round 3, over 70{\%} of survey respondents agreed on the importance of 7 core criteria. These were age ≥ 50 years, duration ≥ 2 weeks, bilateral shoulder and/or pelvic girdle aching, duration of morning stiffness > 45 min, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and rapid steroid response (> 75{\%} global response within 1 wk to prednisolone/prednisone 15-20 mg daily). Among physical signs, more than 70{\%} of survey respondents agreed on the importance of assessing pain and limitation of shoulder (84{\%}) and/or hip (76{\%}) on motion, but agreement was low for peripheral signs like carpal tunnel, tenosynovitis, and peripheral arthritis. Conclusion. There are differences in opinion as to what PMR is and how it should be treated. These findings make it important to develop classification criteria for PMR. The next step is to perform an international prospective study to evaluate the utility of candidate classification criteria for PMR in patients presenting with the polymyalgic syndrome.",
author = "Bhaskar Dasgupta and Carlo Salvarani and Michael Schirmer and Cynthia Crowson and {Maradit Kremers}, {Hilal D} and Andrew Hutchings and Matteson, {Eric Lawrence} and K. Barraclough and H. Bird and K. Calamia and F. Cantini and M. Cid and M. Cimmino and C. Dejaco and W. Docken and L. Guillevin and P. Duhaut and B. Hazelman and G. Hoffman and G. Hunder and Gonzalez-Gay, {M. A.} and C. Langford and B. Leeb and V. Martinez-Taboada and Merkel, {P. A.} and Clement Michet and E. Nordborg and C. Pease and N. Pipitone and W. Schmidt and A. Wagner and P. Bacon",
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AU - Dasgupta, Bhaskar

AU - Salvarani, Carlo

AU - Schirmer, Michael

AU - Crowson, Cynthia

AU - Maradit Kremers, Hilal D

AU - Hutchings, Andrew

AU - Matteson, Eric Lawrence

AU - Barraclough, K.

AU - Bird, H.

AU - Calamia, K.

AU - Cantini, F.

AU - Cid, M.

AU - Cimmino, M.

AU - Dejaco, C.

AU - Docken, W.

AU - Guillevin, L.

AU - Duhaut, P.

AU - Hazelman, B.

AU - Hoffman, G.

AU - Hunder, G.

AU - Gonzalez-Gay, M. A.

AU - Langford, C.

AU - Leeb, B.

AU - Martinez-Taboada, V.

AU - Merkel, P. A.

AU - Michet, Clement

AU - Nordborg, E.

AU - Pease, C.

AU - Pipitone, N.

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AU - Wagner, A.

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N2 - Objective. This report summarizes the findings from a consensus process to identify potential classification criteria for polymyalgia rheumatica (PMR). Methods. A 3-stage hybrid consensus approach was used to develop potential PMR classification criteria. The first stage consisted of a facilitated meeting of 27 international experts who anonymously rated the importance of 68 potential criteria. The second stage involved a meeting of the experts, who were provided with the results of the first round of ratings and were then asked to re-rate the criteria. In the third stage, the wider acceptance of the 43 criteria that received > 50% support at round 2 was evaluated using an extended mailed survey of 111 rheumatologists and 53 nonrheumatologists in the United States, Canada, and Northern and Western Europe. Results. A total of 68 and 50 criteria were identified and rated in round 1 and round 2, respectively. In round 2, 43 of the 50 items achieved at least 50% support, including 10 core criteria achieving 100% support. In round 3, over 70% of survey respondents agreed on the importance of 7 core criteria. These were age ≥ 50 years, duration ≥ 2 weeks, bilateral shoulder and/or pelvic girdle aching, duration of morning stiffness > 45 min, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and rapid steroid response (> 75% global response within 1 wk to prednisolone/prednisone 15-20 mg daily). Among physical signs, more than 70% of survey respondents agreed on the importance of assessing pain and limitation of shoulder (84%) and/or hip (76%) on motion, but agreement was low for peripheral signs like carpal tunnel, tenosynovitis, and peripheral arthritis. Conclusion. There are differences in opinion as to what PMR is and how it should be treated. These findings make it important to develop classification criteria for PMR. The next step is to perform an international prospective study to evaluate the utility of candidate classification criteria for PMR in patients presenting with the polymyalgic syndrome.

AB - Objective. This report summarizes the findings from a consensus process to identify potential classification criteria for polymyalgia rheumatica (PMR). Methods. A 3-stage hybrid consensus approach was used to develop potential PMR classification criteria. The first stage consisted of a facilitated meeting of 27 international experts who anonymously rated the importance of 68 potential criteria. The second stage involved a meeting of the experts, who were provided with the results of the first round of ratings and were then asked to re-rate the criteria. In the third stage, the wider acceptance of the 43 criteria that received > 50% support at round 2 was evaluated using an extended mailed survey of 111 rheumatologists and 53 nonrheumatologists in the United States, Canada, and Northern and Western Europe. Results. A total of 68 and 50 criteria were identified and rated in round 1 and round 2, respectively. In round 2, 43 of the 50 items achieved at least 50% support, including 10 core criteria achieving 100% support. In round 3, over 70% of survey respondents agreed on the importance of 7 core criteria. These were age ≥ 50 years, duration ≥ 2 weeks, bilateral shoulder and/or pelvic girdle aching, duration of morning stiffness > 45 min, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and rapid steroid response (> 75% global response within 1 wk to prednisolone/prednisone 15-20 mg daily). Among physical signs, more than 70% of survey respondents agreed on the importance of assessing pain and limitation of shoulder (84%) and/or hip (76%) on motion, but agreement was low for peripheral signs like carpal tunnel, tenosynovitis, and peripheral arthritis. Conclusion. There are differences in opinion as to what PMR is and how it should be treated. These findings make it important to develop classification criteria for PMR. The next step is to perform an international prospective study to evaluate the utility of candidate classification criteria for PMR in patients presenting with the polymyalgic syndrome.

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