Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus


Dejaco, C; Duftner, C; Cimmino, MA; Dasgupta, B; Salvarani, C; Crowson, CS; Maradit-Kremers, H; Hutchings, A; Matteson, EL; Schirmer, M; (2011) Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus. Annals of the rheumatic diseases, 70 (3). pp. 447-453. ISSN 0003-4967 DOI: https://doi.org/10.1136/ard.2010.133850

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Abstract

Objective To compare current definitions of remission and relapse in polymyalgia rheumatica (PMR) with items resulting from a Delphi-based expert consensus. Methods 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%. Results 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. Conclusions 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.

Item Type: Article
Keywords: GIANT-CELL ARTERITIS, ERYTHROCYTE SEDIMENTATION-RATE, POPULATION-BASED, COHORT, TEMPORAL ARTERITIS, FOLLOW-UP, ACTIVITY SCORE, DISEASE-ACTIVITY, MUSCULOSKELETAL MANIFESTATIONS, CORTICOSTEROID, TREATMENT, DOUBLE-BLIND
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 21097803
Web of Science ID: 286927800008
URI: http://researchonline.lshtm.ac.uk/id/eprint/1106

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