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Rheumatology 2005 44(Supplement 3):iii2-iii3; doi:10.1093/rheumatology/keh731
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Supplement Article

OP6. REVIEW OF DIAGNOSTIC CRITERIA FOR POLYMYALGIA RHEUMATICA/GIANT CELL ARTERITIS

H. A. Bird

Pharmacological Rheumatology, University of Leeds, UK

Polymyalgia rheumatica and giant cell arteritis are nowadays normally accepted as opposite ends of the same disease spectrum. Both conditions are probably manifestations of a vasculitic process. Typically patients with eye involvement present to ophthalmologists; patients with polymyalgia to rheumatologists. Perhaps, as a result, separate criteria sets exist for both conditions.

For giant cell arteritis the criteria adopted by the American College of Rheumatology, based on those proposed by Hunder et al. in 1990 [1], remain the gold standard. Three of the following five criteria are required:

  1. age of onset >50 years
  2. new headache
  3. temporal artery abnormality
  4. increased ESR
  5. abnormal artery biopsy
These have replaced earlier criteria proposed by Wilke and colleagues.

Several criteria sets have been proposed for polymyalgia rheumatica. These include sets from Bird and colleagues [2], Hunder and colleagues [3], Jones and Hazleman, and Nobunaga; the last designed for a Japanese population.

A recent review has suggested that sensitivity is greatest for the Bird/Wood criteria, which identified 99.5% of patients in a multicentre European study and second were those from Hunder, identifying 93.3% of patients, though the criteria from Jones and Hazleman were not fully evaluated, requiring as they do a CRP estimation, which was not available at all participating centres [4].

The Bird/Wood criteria require three out of seven features from:

  1. bilateral shoulder pain and/or stiffness
  2. age >65 years
  3. ESR >40 mm/hr
  4. bilateral upper arm tenderness
  5. morning stiffness >1 hour
  6. onset of illness within two weeks
  7. depression or weight loss or both
Ideally, the criteria should have both a high sensitivity (the proportion of patients with the disease who are positive for the feature, that is the true positive, when related to all individuals with the disease) as well as a high specificity (the proportion of patients without the disease who are negative for the feature, that is the true negative, when related to all individuals without the disease). Analyses are usually based upon the sum of sensitivity and specificity, which is defined as the relative value (range 0–200), which has superseded the Youden Index.

It remains a possibility that existing criteria might need further revision, not least because of our increasing understanding that polymyalgia rheumatica may have a vasculitic aetiology that, in turn, overlaps with other conditions such as Takayasu's arteritis. However, the current criteria should suffice for much needed clinical studies, including those addressing the most appropriate steroid dosage.


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