Correspondence to Professor Michael Schirmer, Department of Internal Medicine I, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
Ann Rheum Dis. 2011 Mar;70(3):447-53. doi: 10.1136/ard.2010.133850. Epub 2010 Nov 19.
To compare current definitions of remission and relapse in polymyalgia rheumatica (PMR) with items resulting from a Delphi-based expert consensus.
Relevant studies including definitions of PMR remission and relapse were identified by literature search in PubMed. The questionnaire used for the Delphi survey included clinical (n=33), laboratory (n=54) and imaging (n=7) parameters retrieved from a literature search. Each item was assessed for importance and availability/practicability, and limits were considered for metric parameters. Consensus was defined by an agreement rate of ≥80%.
Out of 6031 articles screened, definitions of PMR remission and relapse were available in 18 and 34 studies, respectively. Parameters used to define remission and/or relapse included history and clinical assessment of pain and synovitis, constitutional symptoms, morning stiffness (MS), physician's global assessment, headache, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood count, fibrinogen and/or corticosteroid therapy. In the Delphi exercise a consensus was obtained on the following parameters deemed essential for definitions of remission and relapse: patient's pain assessment, MS, ESR, CRP, shoulder and hip pain on clinical examination, limitation of upper limb elevation, and assessment of corticosteroid dose required to control symptoms.
Assessment of patient's pain, MS, ESR, CRP, shoulder pain/limitation on clinical examination and corticosteroid dose are considered to be important in current available definitions of PMR remission and relapse and the present expert consensus. The high relevance of clinical assessment of hips was unique to this study and may improve specificity and sensitivity of definitions for remission and relapse in PMR.
将现有的巨细胞动脉炎（PMR）缓解和复发的定义与基于德尔菲共识的专家意见中的项目进行比较。
通过在 PubMed 中进行文献检索，确定了包含 PMR 缓解和复发定义的相关研究。用于德尔菲调查的问卷包括从文献检索中提取的临床（n=33）、实验室（n=54）和影像学（n=7）参数。每个项目都根据重要性和可用性/可行性进行评估，并为度量参数设定了限制。共识的定义是同意率≥80%。
在筛选出的 6031 篇文章中，有 18 篇和 34 篇分别提供了 PMR 缓解和复发的定义。用于定义缓解和/或复发的参数包括疼痛和滑膜炎的病史和临床评估、全身症状、晨僵（MS）、医生总体评估、头痛、红细胞沉降率（ESR）、C 反应蛋白（CRP）、血细胞计数、纤维蛋白原和/或皮质类固醇治疗。在德尔菲调查中，就以下被认为是缓解和复发定义的基本参数达成了共识：患者的疼痛评估、MS、ESR、CRP、肩部和髋部疼痛的临床检查、上肢抬高受限，以及评估控制症状所需的皮质类固醇剂量。
评估患者的疼痛、MS、ESR、CRP、肩部疼痛/临床检查受限和皮质类固醇剂量被认为是当前 PMR 缓解和复发定义以及本专家共识中的重要因素。对髋关节的临床评估的高度相关性是本研究独有的，这可能提高缓解和复发定义的特异性和敏感性。
