Background/Purpose: To evaluate the diagnostic and discriminative ability of the new 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) classification criteria compared to previous four diagnostic/classification criteria for PMR in a multi-centre prospective study.
Methods: One-hundred and five patients older than 50 years of age, presenting with new onset (symptom duration ≤12 weeks) bilateral shoulder pain with elevated acute phase reactants were enrolled from 9 rheumatology clinics in Turkey. Patients were prospectively followed and the diagnosis of PMR was established when the diagnosis was maintained without an alternative diagnosis at 6 months of follow-up. Those who were diagnosed as other than PMR at the 6thmonth were designated as control group. All patients were classified by each of the five different criteria for PMR and 2010 ACR/EULAR RA classification criteria.
Results: Of the 105 patients with new-onset (mean symptom duration 9.9±7.0 weeks) bilateral shoulder pain 65 (61.9%) patients were diagnosed as PMR and 40 (38.1%) were diagnosed as nonPMR (15 were RA). The discriminative ability as estimated by the area under the receiver operating characteristic (ROC) curve, was better for the Chuang criteria (0.86) than 2012 EULAR/ACR clinical criteria for PMR (0.69), Jones (0.67), Bird (0.66) and Nobunaga (0.75) criterias (Table 1). The 2012 EULAR/ACR clinical criteria for PMR had a sensitivity of 90.8% and a specificity of 47.5%. Jones and Chuang criteria had the highest specificity (90% and 92.5%, respectively). The specificity of the new 2012 EULAR/ACR clinical criteria for PMR further decreased to 40% in RA patients. Although the new 2010 ACR/EULAR RA classification criteria classified only 2 out of 65 PMR patients as RA, the new 2012 EULAR/ACR clinical criteria for PMR classified 9 out of 15 RA patients as PMR.
Conclusion: The new 2012 EULAR/ACR clinical classification criteria for PMR can classify PMR patients with high sensitivity, however, its ability to discriminate PMR from other inflammatory conditions with shoulder pain, especially RA is poor. Another criteria set, Chuang criteria, despite involvement of similar clinical parameters, perform better in discriminating PMR from RA and other inflammatory/noninflammatory articular diseases. This difference may be attributed to the involvement of a cut-off for ESR as 40 mm/h, exclusion of other diagnoses as criteria and classification of patients as PMR when all criteria are fulfilled unlike the new 2012 EULAR/ACR clinical criteria which require just four 4 points. Our results, therefore, suggest that in seronegative patients with bilateral shoulder pain and acute-phase response, differential diagnosis of PMR and RA may require imaging or biomarker studies.
Table 1. Sensitivity and specificity of each set of PMR criteria
|
|
Sensitivity (%) |
Specificity (%) |
AUC (95% CI) |
Specificity (%) |
AUC (95% CI) |
|
Criteria |
PMR vs Total Cases |
PMR vs RA |
|||
|
Chuang |
80 |
92.5 |
0.86 (0.78-0.93) |
93.3 |
0.86 (0.77-0.96) |
|
Bird |
92.3 |
40 |
0.66 (0.54-0.77) |
13.3 |
0.52 (0.36-0.69) |
|
Jones |
44.6 |
90 |
0.67 (0.57- 0.77) |
93.3 |
0.69 (0.56-0.81) |
|
Nobunaga |
73.8 |
77.5 |
0.75 (0.65-085) |
80 |
0.76 (0.63-0.90) |
|
EULAR/ACR |
90.8 |
47.5 |
0.69 (0.58-0.80) |
40 |
0.65 (0.48-0.82) |
Disclosure:
G. Ozen,
None;
S. Bas,
None;
A. U. Unal,
None;
G. Kimyon,
None;
A. M. Onat,
None;
M. Can,
None;
A. Mengi,
None;
A. Sahin,
None;
S. Yilmaz,
None;
H. Keskin,
None;
S. Murat,
None;
A. Balkarli,
None;
V. Cobankara,
None;
O. N. Pamuk,
None;
Y. Cagatay,
None;
N. Yilmaz,
None;
I. Yagci,
None;
P. Atagunduz,
None;
S. Z. Aydin,
None;
N. Inanc,
None;
H. Direskeneli,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/validation-of-new-2012-eularacr-classification-criteria-for-polymyalgia-rheumatica-comparison-with-the-previous-criteria-in-a-prospective-multi-center-study/