Usefulness of the disease activity scores for polymyalgia rheumatica for predicting glucocorticoid dose changes: A study of 243 scenarios

✍ Scribed by Binard, Aymeric ;De Bandt, Michel ;Berthelot, Jean-Marie ;Saraux, Alain ;,

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 85 KB
• Volume: 57
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.22630

✦ Synopsis

Abstract

Objective

To evaluate associations linking glucocorticoid dose changes in patients with polymyalgia rheumatica (PMR) to the PMR activity score (PMR‐AS) and its components.

Methods

Nine clinical vignettes of PMR were written by a panel of experts and submitted to 35 rheumatologists, who were asked to assess disease activity using a visual analog scale (VASph) and to determine whether there was a relapse of PMR requiring an increase in the glucocorticoid dose. In 7 vignettes, >80% of the rheumatologists agreed on the diagnosis of relapse justifying the glucocorticoid dose decision. A total of 243 vignette‐physician combinations were obtained. Using these vignettes, we evaluated statistical associations linking a decision to increase the glucocorticoid dose to the value of PMR‐AS, of its components (VASph, visual analog scale for pain [VASp], C‐reactive protein level [CRP], morning stiffness [MST], and elevation of upper limbs [EUL]), or to the difference in these variables between the last 2 visits (dPMR‐AS, dVASph, dVASp, dCRP, dMST, and dEUL).

Results

The strongest associations with a decision to increase the glucocorticoid dose occurred with dPMR‐AS >4.2, dMST >10 minutes, dVASph >1.55, and dCRP >4 mg/dl (99.3% sensitivity, 100% specificity for all 4 variables); MST ≥10 minutes (100% sensitivity, 99.3% specificity); PMR‐AS ≥7 (98.1% sensitivity, 94.3% specificity); VASph ≥2.25 (94.2% sensitivity, 83.6% specificity); and CRP level ≥14.5 mg/liter (66.3% sensitivity, 99.3% specificity).

Conclusion

Despite inter‐individual variations in VASph, PMR‐AS was a good indicator of disease activity. However, MST, dMST, dVASph, dPMR‐AS, and dCRP performed better than PMR‐AS. These variables may be useful in tailoring the glucocorticoid dose to the individual needs of each patient.