365For patients with PMR being able to perform common activities of daily living was
described as the most important aspect of their disease that would indirectly refl ect
their morning stiffness [ 24 ].
Other domains such as patient global assessment, fatigue, quality of life, anxiety,
and depression were infrequently reported in PMR studies, though they appear
important from the patient’s point of view [ 8 ]. Although the domains “pain” and
“function” are relatively straightforward, the patient global assessment is more dif-
fi cult to interpret [ 32 ]. This measure was initially developed in RA but is now com-
monly utilized in other rheumatic diagnoses with different formulations. Differences
in formulation and interpretation may infl uence the poor concordance seen between
patient and physician global assessments documented in many rheumatic diseases
[ 44 ], which have been associated with poorer outcomes [ 45 ].
PMR has an important impact in patients’ quality of life (QOL). Changes in pain
and morning stiffness have been strongly associated with changes in the physical
aspect of the SF-36, whereas changes in acute-phase reactants markers have been
shown to be strongly associated with changes in the mental component [ 41 ]. The
impaired mental QOL and depression commonly seen in PMR patients could be
related to the neurologic effects of circulating cytokines, such as interleukin-6,
which is elevated in PMR and may have signifi cant effects on the central nervous
system [ 46 ].
Assessment of a patient with PMR requires a careful history and physical exami-
nation, as well as relevant laboratory tests, including ESR and CRP, to formulate an
optimal treatment plan for each individual patient. Quantitative PROs may add to
clinical decisions, and to documentation of clinical improvement in individual
patients with PMR. The MDHAQ appears to be a valuable tool to collect PROs in
routine care, being suitable not only for PMR but also for any rheumatic condition.
In summary, PROs can be useful for better monitoring of disease activity and
evaluating treatment response in PMR. Pain is the most important domain in patients
with PMR and it has been systematically included in diagnostic criteria and the
evaluation of disease activity. While morning stiffness is an important symptom for
patients, there is no consistency about how it should be measured and presents sev-
eral limitations. Multiple domains that are important for the patients are not rou-
tinely evaluated. Further work is needed to obtain a better insight of which outcomes
should be necessary to incorporate the patient’s perspective.
14 PROMs for Polymyalgia Rheumatica