2012 classification criteria for polymyalgia rheumatica

In 2012, the American College of Rheumatology and the European League Against Rheumatism have defined new classification criteria for polymyalgia rheumatica (PMR). Are these criteria effective in clinical practice? What have been the major changes introduced in the last update?

Bhaskar Dasgupta: The most important aspect of the classification criteria is that they make a point of excluding other conditions. So, the important line in the classification criteria is new-onset bilateral shoulder pain not better explained by any other condition. It comes with a scoring algorithm and gives 2 marks for morning stiffness, 2 marks if you have rheumatoid serology negative, 1 mark if there is additional hip pain, and 1 mark if you have additional absence of peripheral arthritis.

The most important thing about the classification criteria is that they are the first classification criteria that have introduced imaging. We have ultrasound abnormalities of PMR-related lesions in the shoulders, such as subdeltoid/subacromial bursitis, or hip effusion. You can get 1 additional point for shoulder and hip or 1 additional point for both shoulders being involved.

The main benefit of the classification criteria is, of course, to help with clinical trials – because now we are doing clinical trials in PMR of other medications apart from steroids. But [thanks to] the way we have developed the classification criteria, you can also use them to help as diagnostic criteria for PMR.