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リウマチ性多発筋痛症(PMR)の診断アルゴリズム

GCA=巨細胞性動脈炎(giant cell arteritis)、RA=関節リウマチ(rheumatoid arthritis)
出典
img
1: Goldman L, Schafer AI (eds.): Goldman-Cecil Medicine, 25th edition. Philadelphia: WB Saunders, 2015: 1801-1805. FIGURE  271-1(一部改変)

ACR/EULAR PMR分類基準

これまで国際的に統一された診断/分類基準はなかったが、2012年に米国リウマチ学会・欧州リウマチ学会が合同で暫定的分類基準を発表したので、それを示す。
出典
imgimg
1: 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.
著者: Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Del Amo M, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Marcus R, Gonter NJ, Maz M, Carter RE, Crowson CS, Matteson EL.
雑誌名: Arthritis Rheum. 2012 Apr;64(4):943-54. doi: 10.1002/art.34356.
Abstract/Text: The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of rheumatoid factor and/or anti-citrullinated protein antibody (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness >45 minutes, elevated C-reactive protein and/or erythrocyte sedimentation rate, and new hip pain. These criteria are not meant for diagnostic purposes.

Copyright © 2012 by the American College of Rheumatology.
Arthritis Rheum. 2012 Apr;64(4):943-54. doi: 10.1002/art.34356.

リウマチ性多発筋痛症(PMR)の診断アルゴリズム

GCA=巨細胞性動脈炎(giant cell arteritis)、RA=関節リウマチ(rheumatoid arthritis)
出典
img
1: Goldman L, Schafer AI (eds.): Goldman-Cecil Medicine, 25th edition. Philadelphia: WB Saunders, 2015: 1801-1805. FIGURE  271-1(一部改変)

ACR/EULAR PMR分類基準

これまで国際的に統一された診断/分類基準はなかったが、2012年に米国リウマチ学会・欧州リウマチ学会が合同で暫定的分類基準を発表したので、それを示す。
出典
imgimg
1: 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.
著者: Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Del Amo M, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Marcus R, Gonter NJ, Maz M, Carter RE, Crowson CS, Matteson EL.
雑誌名: Arthritis Rheum. 2012 Apr;64(4):943-54. doi: 10.1002/art.34356.
Abstract/Text: The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of rheumatoid factor and/or anti-citrullinated protein antibody (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness >45 minutes, elevated C-reactive protein and/or erythrocyte sedimentation rate, and new hip pain. These criteria are not meant for diagnostic purposes.

Copyright © 2012 by the American College of Rheumatology.
Arthritis Rheum. 2012 Apr;64(4):943-54. doi: 10.1002/art.34356.