Clearer criteria are needed for PMR diagnosis

STANDARD national guidelines are needed to improve the diagnosis and management of polymyalgia rheumatica (PMR) in primary care, Australian rheumatologists say.

They were commenting on UK research that concluded GPs often did not appear to have used published diagnostic criteria to diagnose PMR.

Researchers identified 183 patients diagnosed as having PMR. However, of these 11% had normal inflammatory indices, and another 2% had no measurement of inflammatory markers.

Professor Geoffrey McColl, president of the Rheumatology Association, said the findings showed standardised diagnostic criteria were needed to combat overdiagnosis of PMR.

He said GPs needed to be aware of standard indicators of PMR, which include the presence of inflammatory-type muscle pain, raised inflammatory markers and a positive response to corticosteroids.

However, Dr Ric Day, professor of clinical pharmacology at the University of NSW, believed there was also a risk of underdiagnosis of the condition, and guidelines might prevent common delays in diagnosis.

“It would be helpful to have some more guidance for primary care in particular, and advice on what to exclude... and when to refer when you are uncertain.”

Common pitfalls in reaching a diagnosis included insufficient ESR serum levels or non-exclusion of other non-inflammatory conditions, for example in the cervical spine or musculoskeletal system.

The UK authors said there were currently moves to develop standard international classification criteria for polymyalgia.

Family Practice 2008; 25:328-33.