Recommendations for early referral of individuals with suspected polymyalgia rheumatica: An initiative from the international giant cell arteritis and polymyalgia rheumatica study group

Kresten Krarup Keller, Chetan B. Mukhtyar, Andreas Wiggers Nielsen, Andrea Katharina Hemmig, Sarah Louise Mackie, Sebastian Eduardo Sattui, Ellen Margrethe Hauge, Anisha Dua, Toby Helliwell, Lorna Neill, Daniel Blockmans, Valérie Devauchelle-Pensec, Eric Hayes, Annett Jansen Venneboer, Sara Monti, Cristina Ponte, Eugenio De Miguel, Mark Matza, Kenneth J. Warrington, Kevin ByramKinanah Yaseen, Christine Peoples, Michael Putman, Lindsay Lally, Michael Finikiotis, Simone Appenzeller, Ugo Caramori, Carlos Enrique Toro-Gutiérrez, Elisabeth Backhouse, María Camila Guerrero Oviedo, Victor Román Pimentel-Quiroz, Helen Isobel Keen, Claire Elizabeth Owen, Thomas Daikeler, Annette de Thurah, Wolfgang A. Schmidt, Elisabeth Brouwer, Christian Dejaco

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Abstract

Objective To develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR). Methods A task force including 29 rheumatologists/ internists, 4 general practitioners, 4 patients and a healthcare professional emerged from the international giant cell arteritis and PMR study group. The task force supplied clinical questions, subsequently transformed into Population, Intervention, Comparator, Outcome format. A systematic literature review was conducted followed by online meetings to formulate and vote on final recommendations. Levels of evidence (LOE) (1–5 scale) and agreement (LOA) (0–10 scale) were evaluated. Results Two overarching principles and five recommendations were developed. LOE was 4–5 and LOA ranged between 8.5 and 9.7. The recommendations suggest that (1) each individual with suspected or recently diagnosed PMR should be considered for specialist evaluation, (2) before referring an individual with suspected PMR to specialist care, a thorough history and clinical examination should be performed and preferably complemented with urgent basic laboratory investigations, (3) individuals with suspected PMR with severe symptoms should be referred for specialist evaluation using rapid access strategies, (4) in individuals with suspected PMR who are referred via rapid access, the commencement of glucocorticoid therapy should be deferred until after specialist evaluation and (5) individuals diagnosed with PMR in specialist care with a good initial response to glucocorticoids and a low risk of glucocorticoid related adverse events can be managed in primary care. Conclusions These are the first international recommendations for referral of individuals with suspected PMR, which complement the European Alliance of Associations for Rheumatology/American College of Rheumatology management guidelines for established PMR.

Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Early online date1 Dec 2023
DOIs
Publication statusE-pub ahead of print - 1 Dec 2023
Externally publishedYes

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