A score of 5 using this algorithm has 71% sensitivity and 70% specificity for discriminating all comparison subjects from PMR. The specificity is higher (85%) for discriminating shoulder conditions from PMR, and lower (65%) for discriminating rheumatoid arthritis from PMR, Dr. Matteson noted.
Clues that a patient does not have PMR include younger age, chronic onset, male gender, severe constitutional symptoms, lack of shoulder involvement, peripheral arthritis, rheumatoid factor–positive/ACPA status, normal acute phase reactants (CRP, ESR) levels, peripheral arthritis, foot and ankle involvement, and poor response to low-dose corticosteroids. Also, keep in mind that the closest mimic of PMR is late-onset spondyloarthropathy, he said.
The severity of PMR is based on the intensity of pain, stiffness, and disability. Comorbidities should also be assessed, as these may affect the choice of corticosteroid dose. The corticosteroid dose, as well as other therapy, should be individualized based on the severity and comorbidities, and on the patient’s preference.
Patients diagnosed with PMR should be educated about the disease, its treatment and the potential related complications, and about precautions and monitoring requirements, Dr. Matteson said. Range-of-motion exercises for the shoulder and pelvic girdle muscles should be encouraged, and referral to physiotherapy should be made if necessary.
Patients should be monitored for relapse; in a recent study, relapse-free survival at 1 year and 2 years among patients with PMR was 68.8% and 42.4%, respectively, he noted.
Dr. Matteson reported serving as an advisory board member for Janssen; providing editorial services for UpToDate and inPractice; receiving research grants from the ACR, EULAR, Celgene, Biogen Idec, Centocor/Janssen, Genentech, Novartis, Roche, Ardea Biosciences, UCB Group, Sanofi, the Veterans Administration, the National Institutes of Health, Pfizer, and Mesoblast; and owning stock in Exact Sciences.
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