Early referral of patients with suspected polymyalgia rheumatica – A systematic review

Nielsen, A. W., Hemmig, A. K., de Thurah, A., Schmidt, W. A., Sattui, S. E., Mackie, S. L., Brouwer, E., Dejaco, C., Keller, K. K. and Mukhtyar, C. B. ORCID: https://orcid.org/0000-0002-9771-6667 (2023) Early referral of patients with suspected polymyalgia rheumatica – A systematic review. Seminars in Arthritis and Rheumatism, 63. ISSN 0049-0172

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Introduction: Prompt diagnosis and treatment of polymyalgia rheumatica (PMR) is crucial to prevent long-term complications and improve patient outcomes. However, there is currently no standardized approach to referral of suspected PMR patients to rheumatologists, leading to inconsistent management practices. The objective of this systematic review was to clarify the existing evidence regarding the following aspects of early management strategies in patients with suspected PMR: diagnostic strategies, GCA screening, glucocorticoid initiation prior to referral, value of shared care and value of fast track clinic. Methods: Two authors performed a systematic literature search, data extraction and risk of bias assessment independently. The literature search was conducted in Embase, MEDLINE (PubMed) and Cochrane. Studies were included if they contained cohorts of suspected PMR patients and evaluated the efficacy of different diagnostic strategies for PMR, screening for giant cell arteritis (GCA), starting glucocorticoids before referral to secondary care, shared care, or fast-track clinics. Results: From 2,437 records excluding duplicates, 14 studies met the inclusion criteria. Among these, 10 studies investigated the diagnostic accuracy of various diagnostic strategies with the majority evaluating different clinical approaches, but none of them showed consistently high performance. However, 4 studies on shared care and fast-track clinics showed promising results, including reduced hospitalization rates, lower starting doses of glucocorticoids, and faster PMR diagnosis. Conclusion: This review emphasizes the sparse evidence of early management and referral strategies for patients with suspected PMR. Additionally, screening and diagnostic strategies for differentiating PMR from other diseases, including concurrent GCA, require clarification. Fast-track clinics may have potential to aid patients with PMR in the future, but studies will be needed to determine the appropriate pre-referral work-up.

Item Type: Article
Additional Information: Funding Information: Kresten Krarup Keller and Andreas Wiggers Nielsen have received grants from Health Research Foundation of Central Denmark and Aarhus University Hospital for research in polymyalgia rheumatica. Andrea Hemmig's PhD scholarship is supported by the Swiss Foundation for Research on Muscle Diseases (FSRMM). Sebastian E. Sattui is supported by the Rheumatology Research Foundation RISE Pilot Award and by the Bristol Myers Squibb Foundation Robert A. Winn Diversity in Clinical Trials Career Development Award, outside of the submitted work. Chetan B Mukhtyar has funding to do research for 1 day a week from the National Health Service. Funding Information: The authors would like to acknowledge the contribution of the PMR Referrals Recommendation Task Force consisting of; Anisha Dua (Chicago, USA), A. Venneboer (Groningen, The Netherlands), Carlos Toro (Cali, Columbia), Christine Peoples (Pittsburgh, USA), Claire E. Owen (Melbourne, Australia), Cristina Ponte (Lisbon, Portugal), Daniel Blockmans (Leuven, Belgium), Elizabeth Backhouse (Melbourne, Australia), centre, Ellen-Margrethe Hauge (Aarhus, Denmark), Eric Hayes (Aarhus, Denmark), Eugenio de Miguel (Madrid, Spain), Helen Keen (Perth, Australia), Kenneth J. Warrington (Rochester, USA), Kevin Byram (Nashville, USA), Kinanah Yaseen (Cleveland, USA), Lindsay Lally (New York, USA), Lorna Neill (Norfolk, UK), Maria C. Guerrero (Bogota, Columbia), Mark A. Matza (Boston, USA), Michael Finikiotis (Pittsburgh, USA), Michael Putman (Milwaukee, USA), Sara Monti (Pavia, Italy), Simone Appenzeller (Campinas, Brazil), Thomas Daikeler (Basel, Switzerland), Toby Helliwell (Keele, UK), Ugo Caramori (Campinas, Brazil), Valérie Devauchelle-Pensec (Brest, France), and Victor R. Pimentel-Quiroz (La Victoria, Peru). Publisher Copyright: © 2023 Elsevier Inc.
Uncontrolled Keywords: diagnostic strategy,early referral,fast-track clinic,gca screening,polymyalgia rheumatica,shared care,rheumatology,anesthesiology and pain medicine ,/dk/atira/pure/subjectarea/asjc/2700/2745
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Depositing User: LivePure Connector
Date Deposited: 22 Oct 2023 01:09
Last Modified: 25 Oct 2023 02:24
URI: https://ueaeprints.uea.ac.uk/id/eprint/93396
DOI: 10.1016/j.semarthrit.2023.152260

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