© Springer International Publishing Switzerland 2016 357
Y. El Miedany (ed.), Patient Reported Outcome Measures in Rheumatic Diseases,
DOI 10.1007/978-3-319-32851-5_14
Chapter 14
PROMs for Polymyalgia Rheumatica
Isabel Castrejon
Introduction
Polymyalgia rheumatica ( PMR ) is a common infl ammatory disease of elderly
patients affecting from 0.1 to 0.5 % of the over-50-year-old population [ 1 ]. PMR is
characterized by proximal pain, especially in the shoulder and pelvic girdle, and
morning stiffness with high acute-phase reactants. Even though an elevation of
acute-phase reactants may be not present, this does not necessarily indicate lesser
severity or better prognosis [ 2 ]. The initial presentation may also mimic other rheu-
matic conditions—explaining the diffi culty of diagnosis and a lack of agreement
between physicians [ 3 ]. Because of the heterogeneity in the disease course and the
lack of diagnostic laboratory test, physicians mainly rely on the clinical picture sup-
ported by a rapid response to glucocorticoids to make the diagnosis.
Glucocorticoids are the preferred treatment, leading to a rapid and dramatic
improvement, but they may be required for several years in some patients [ 4 ]. PMR
is a common indication for long-term steroid use in the community associated with
serious adverse effects such as diabetes, osteoporosis, and infections [ 5 ].
A rapid resolution of symptoms after glucocorticoids is therefore a diagnostic
hallmark, but there is no consensus on what constitutes an appropriate response and
which outcomes should be monitored. The lack of reliable and sensitive measures
to evaluate disease activity and the lack of standardized classifi cation criteria to
identify patients with PMR may explain the limited evidence for effi cacy of any
treatment different from glucocorticoids [ 6 ].
Current clinical guidelines recommend monitoring patients treated for PMR on
the basis of symptoms since, as previously noted, conventional infl ammatory
I. Castrejon , M.D., Ph.D. (*)
Division of Rheumatology , Rush University Medical Center , Chicago , IL , USA
e-mail: [email protected]; [email protected]