Dasgupta Bhaskar, Cimmino Marco A, Kremers Hilal Maradit, Schmidt Wolfgang A, Schirmer Michael, Salvarani Carlo, Bachta Artur, Dejaco Christian, Duftner Christina, Jensen Hanne Slott, Duhaut Pierre, Poór Gyula, Kaposi Novák Pál, Mandl Peter, Balint Peter V, Schmidt Zsuzsa, Iagnocco Annamaria, Nannini Carlotta, Cantini Fabrizio, Macchioni Pierluigi, Pipitone Nicolò, Del Amo Montserrat, Espígol-Frigolé Georgina, Cid Maria C, Martínez-Taboada Víctor M, Nordborg Elisabeth, Direskeneli Haner, Aydin Sibel Zehra, Ahmed Khalid, Hazleman Brian, Silverman Barbara, Pease Colin, Wakefield Richard J, Luqmani Raashid, Abril Andy, Michet Clement J, Marcus Ralph, Gonter Neil J, Maz Mehrdad, Carter Rickey E, Crowson Cynthia S, Matteson Eric L
Southend University Hospital, Westcliff-on-Sea, UK.
Arthritis Rheum. 2012 Apr;64(4):943-54. doi: 10.1002/art.34356.
The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of rheumatoid factor and/or anti-citrullinated protein antibody (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness >45 minutes, elevated C-reactive protein and/or erythrocyte sedimentation rate, and new hip pain. These criteria are not meant for diagnostic purposes.
本研究的目的是制定欧洲抗风湿病联盟/美国风湿病学会的风湿性多肌痛（PMR）分类标准。在一项为期6个月的前瞻性队列研究中，对125例新发PMR患者和169例患有类似PMR病症的非PMR对照受试者的候选标准进行了评估。基于晨僵>45分钟（2分）、髋部疼痛/活动范围受限（1分）、类风湿因子和/或抗瓜氨酸化蛋白抗体阴性（2分）以及无外周关节疼痛（1分）制定了评分算法。评分≥4对区分所有对照受试者与PMR的敏感性为68%，特异性为78%。区分肩部疾病与PMR时特异性较高（88%），区分类风湿关节炎（RA）与PMR时特异性较低（65%）。加入超声检查后，评分≥5时敏感性提高到66%，特异性提高到81%。根据这些临时分类标准，年龄≥50岁、出现双侧肩部疼痛且无法用其他病理情况更好解释的患者，若同时存在晨僵>45分钟、C反应蛋白和/或红细胞沉降率升高以及新发髋部疼痛，可被分类为患有PMR。这些标准并非用于诊断目的。
