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

Keller, Kresten Krarup, Mukhtyar, Chetan B. ORCID:, Nielsen, Andreas Wiggers, Hemmig, Andrea Katharina, Mackie, Sarah Louise, Sattui, Sebastian Eduardo, Hauge, Ellen Margrethe, Dua, Anisha, Helliwell, Toby, Neill, Lorna, Blockmans, Daniel, Devauchelle-Pensec, Valérie, Hayes, Eric, Venneboer, Annett Jansen, Monti, Sara, Ponte, Cristina, De Miguel, Eugenio, Matza, Mark, Warrington, Kenneth J., Byram, Kevin, Yaseen, Kinanah, Peoples, Christine, Putman, Michael, Lally, Lindsay, Finikiotis, Michael, Appenzeller, Simone, Caramori, Ugo, Toro-Gutiérrez, Carlos Enrique, Backhouse, Elisabeth, Oviedo, María Camila Guerrero, Pimentel-Quiroz, Victor Román, Keen, Helen Isobel, Owen, Claire Elizabeth, Daikeler, Thomas, de Thurah, Annette, Schmidt, Wolfgang A., Brouwer, Elisabeth and Dejaco, Christian (2023) Recommendations for early referral of individuals with suspected polymyalgia rheumatica: An initiative from the international giant cell arteritis and polymyalgia rheumatica study group. Annals of the Rheumatic Diseases. ISSN 0003-4967

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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.

Item Type: Article
Additional Information: Publisher Copyright: © Author(s) (or their employer(s)) 2023.
Uncontrolled Keywords: rheumatology,immunology and allergy,immunology,biochemistry, genetics and molecular biology(all) ,/dk/atira/pure/subjectarea/asjc/2700/2745
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Depositing User: LivePure Connector
Date Deposited: 14 Mar 2024 15:30
Last Modified: 15 Mar 2024 10:30
DOI: 10.1136/ard-2023-225134


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