Polymyalgia rheumatica

Working group OMERACT >  Polymyalgia rheumatica

MENTOR:

Annamaria Iagnocco

George Bruyn

Objective of the subgroups work: 

To agree upon new definitions for key elementary ultrasound lesions in polymyalgia rheumatica (PMR)

To test the reliability of these definition in a Web-based and patient-based exercise

What is the contribution of the subgroup work to the OMERACT work?

Diagnosis and outcome measurement in PMR largely rely on patient history and CRP / ESR, which, however, are non-specific. For diagnosis, ultrasound has been demonstrated to increase specificity over clinical examination alone, particularly concerning the differentiation of PMR from degenerative diseases; however, still there is no accepted definition of the elementary ultrasound lesions in PMR.

The most important outcome measures in PMR are remission and relapse. However, as patients often have concomitant osteoarthritis and other pain syndromes, it is often difficult to distinguish a flare of PMR from an exacerbation of degenerative pain. Besides, there are promising studies on the use of tocilizumab in PMR, and currently, there is an ongoing placebo controlled trial to test the drug in these patients. As tocilizumab induces a normalisation of inflammatory markers, it becomes more difficult to assess flares in PMR. In this situation, ultrasound may be a relevant outcome measure of disease activity.

Description of the previous work

The work of this subgroup has started in March 2018. An update of an SLR on the diagnostic accuracy of imaging in PMR (Mackie et al. in 2015) is currently conducted. Data on the diagnostic value of ultrasound for PMR as well as previously used definitions of ultrasound abnormalities will be extracted and preliminary results will be presented at the OMERACT meeting at EULAR.

Reporting back of work done since ACR 2017

The group was founded in 2018

Next steps and discussion points

1.      Completion of the update of the SLR of Mackie et al. RMD open, 2015

2.      Delphi exercise to agree upon definitions of key ultrasound lesions for PMR

3.      Web-based reliability exercise on the newly defined key lesions

4.      Patient based exercise

Publication strategy: SLR update, Delphi and Web-based exercise will bepublished together, a second paper will be drafter on the patient-based reliability exercise.