Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group
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Published:2023-12-01
Issue:
Volume:
Page:ard-2023-225134
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ISSN:0003-4967
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Container-title:Annals of the Rheumatic Diseases
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language:en
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Short-container-title:Ann Rheum Dis
Author:
Keller Kresten KrarupORCID, Mukhtyar Chetan BORCID, Nielsen Andreas WiggersORCID, Hemmig Andrea KatharinaORCID, Mackie Sarah Louise, Sattui Sebastian EduardoORCID, Hauge Ellen-Margrethe, Dua AnishaORCID, Helliwell Toby, Neill Lorna, Blockmans Daniel, Devauchelle-Pensec Valérie, Hayes Eric, Venneboer Annett Jansen, Monti SaraORCID, Ponte CristinaORCID, De Miguel EugenioORCID, Matza Mark, Warrington Kenneth J, Byram Kevin, Yaseen Kinanah, Peoples Christine, Putman Michael, Lally Lindsay, Finikiotis Michael, Appenzeller SimoneORCID, Caramori Ugo, Toro-Gutiérrez Carlos Enrique, Backhouse Elisabeth, Oviedo María Camila Guerrero, Pimentel-Quiroz Victor RománORCID, Keen Helen Isobel, Owen Claire ElizabethORCID, Daikeler Thomas, de Thurah AnnetteORCID, Schmidt Wolfgang AORCID, Brouwer ElisabethORCID, Dejaco ChristianORCID
Abstract
ObjectiveTo develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR).MethodsA 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.ResultsTwo 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.ConclusionsThese 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.
Subject
General Biochemistry, Genetics and Molecular Biology,Immunology,Immunology and Allergy,Rheumatology
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