English2012 provisional classification criteria for polymyalgia rheumatica
canada goose coats on sale The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6 month prospective cohort study of 125 patients with new onset PMR and 169 non PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of RF and/or ACPA (2 points), and absence of peripheral joint pain (1 point). A score 4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) Canada Goose Outlet for discriminating RA from PMR. Adding ultrasound, a score 5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients 50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness>45 minutes, elevated CRP and/or ESR and new hip pain. These criteria are not meant for diagnostic purposes. However, there is canada goose black friday sale little hard evidence to substantiate this assertion. A previous Canada Goose Jackets report showed that 3 weeks after starting prednisolone 15 mg a day only 55% showed a complete response to therapy.10 This also emphasises that clinical trials of novel effective agents are needed in PMR. canada goose coats on sale
canada goose factory sale The lack of standardised classification criteria has buy canada goose jacket been a major factor hampering the development of rational therapeutic approaches12 16 17 and causing difficulties in evaluating patients in clinical studies. In response to a European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) initiative, a criteria development work group convened in 2005. canada goose factory sale
A systematic literature review, a three phase hybrid consensus process and a wider survey were undertaken to identify candidate criteria items.18 The first stage consisted of a meeting of 27 international experts who anonymously rated 68 potential criteria identified through literature review. In the second round the experts were provided with the results of the first round and re rated the criteria items. In the third round, the wider acceptance of the chosen criteria (>50% support) was evaluated using a survey of canada goose clearance sale 111 rheumatologists and 53 non rheumatologists in North America and western Europe.
canada goose black friday sale In round three, over 70% of respondents agreed on the importance of seven core criteria (all achieving 100% support in round two). These were aged 50 years or older, symptom duration 2 weeks or longer, bilateral shoulder and/or pelvic girdle aching, duration of morning stiffness more than 45 Canada Goose sale min, elevated erythrocyte sedimentation rate (ESR), elevated C reactive protein (CRP) and rapid corticosteroid response. More than 70% agreed on assessing pain and limitation of shoulder (84%) and/or hip (76%) on motion, but agreement was low for peripheral signs (eg, carpal tunnel syndrome, tenosynovitis, peripheral arthritis). canada goose black friday sale
Canada Goose Online The group reached consensus on the need for a prospective cohort study to evaluate the canada goose deals disease course from presentation in patients included on the basis of proximal pain and stiffness with evaluations over a 6 month period while receiving a standardised corticosteroid treatment regimen.7 18,,25 The group also agreed to assess musculoskeletal ultrasound as part of the PMR classification criteria. In this paper, we present the results from this prospective study and propose new classification criteria for PMR. Canada Goose Online
cheap Canada Goose Consensus decisions about study design cheap Canada Goose
cheap canada goose uk A priori, the work group decided that a specific approach should be adopted for classifying newly presenting patients with bilateral shoulder pain as PMR.18 The group agreed on the following: cheap canada goose uk
Canada Goose Parka Patients presenting with polymyalgic syndrome should have stepwise evaluation on the basis of inclusion and exclusion criteria, response to a standardised corticosteroid challenge and follow up confirmation. The criteria items would be agreed upon clinical features and laboratory investigations. Canada Goose Parka
Canada Goose Outlet The need to standardise response to corticosteroid therapy in PMR. Because the goal of classification criteria is to identify patients for Canada Goose online enrollment into clinical trials before any treatment, the response to corticosteroid therapy should be used in verifying the classification of a patient as having PMR, although it should not be used as a cheap Canada Goose classification criterion. Because scientific evidence is poor as to what constitutes such a response it was agreed (>75% agreement) this response would be defined as greater than 75% global response in clinical and laboratory parameters within 7 days to corticosteroid challenge with oral 15 mg prednisone or prednisolone and subsequent resolution of inflammatory indices.18 Canada Goose Outlet
That a prospective study would be needed to evaluate the disease course from presentation in patients included on the basis of the mandatory ‘core’ criteria of proximal pain and stiffness. New onset bilateral shoulder pain was selected as the main eligibility criterion as the percentage of PMR presenting with hip pain without shoulder pain was very small (18 The study would evaluate at prespecified intervals symptoms, examination, investigations and their evolution with standardised corticosteroid https://www.getcanadagooseoutlet.com treatment in a prospective cohort of patients with new onset bilateral shoulder pain (comparing the PMR case cohort with the comparator cohort of mimicking conditions) over a 6 month period.
uk canada goose Musculoskeletal ultrasound should be evaluated in a substudy as a feasible mode of investigation of possible PMR. A secondary objective of this substudy would be the evaluation of clinical and patient based outcomes in PMR over a 6 month period.26 27The study was a prospective cohort study that included a cohort of patients with new onset PMR and a comparison cohort of non PMR patients with various conditions mimicking PMR. Study subjects were recruited from 21 community based and academic rheumatology clinics in 10 European countries and the USA. Inclusion criteria for PMR patients were age 50 years or older, new onset bilateral shoulder pain and no corticosteroid treatment (for any condition) within 12 weeks before study entry, fulfilling all the inclusion and exclusion criteria defined by our previous report and in accordance with the judgement of the participating investigator that the patient had PMR.18 Every effort was made to choose patients across the spectrum of disease severity. Corticosteroid treatment for PMR patients was initiated according to a predefined treatment protocol starting with 15 mg a day oral prednisone for weeks 1 and 2, 12.5 mg a day for weeks 3 and 4, 10 mg a day for weeks 6 11, 10 canada goose store mg/7.5 mg every other day for weeks 12 15, 7.5 mg a day for weeks 16 25 and tapering according to treatment response from week 26 onwards. The gold standard for the pre steroid diagnosis of PMR was established as above at presentation and when the diagnosis was maintained without an alternative diagnosis at week 26 of follow up. uk canada goose
Canada Goose Jackets The non PMR comparison cohort included conditions representative of the types that need to be distinguished from PMR, in both primary and secondary care. Inclusion criteria for the non PMR comparison cohort were age 50 years or older, new onset bilateral shoulder pain and a diagnosis of either inflammatory or non inflammatory conditions, including new onset RA, connective tissue diseases, various shoulder conditions (eg, bilateral rotator cuff syndrome and/or adhesive capsulitis, rotator cuff tear, glenohumeral osteoarthritis), fibromyalgia, generalised osteoarthritis and others. Patients known to have the condition for more than 12 weeks before the baseline evaluation (except fibromyalgia and chronic pain) were not eligible for inclusion. PMR patients with clinical suspicion of giant cell arteritis canada goose coats on sale were included as part of the comparison cohort because these patients required different corticosteroid doses. Patients in the comparison cohort were included on the basis of clinician diagnosis and not on formal criteria. No guidelines were provided for treatment of the conditions in the comparison cohort. Canada Goose Jackets
canada goose clearance Ethics board approval was obtained at all participating institutions before initiation of the study, and all participants gave written informed consent before enrollment. canada goose clearance
canada goose clearance sale Follow up and data collection canada goose clearance sale
PMR patients were evaluated at baseline, and at 1, 4, 12 and 26 weeks. At each follow up visit, clinical evaluation included response to corticosteroid therapy and opinion on canadian goose jacket the emergence of alternative diagnoses. Patients not considered as canada goose having PMR at any time were evaluated and treated according to accepted clinical practice. They were excluded from the PMR cohort and included in the non PMR comparison cohort. Patients in the comparison cohort were evaluated at baseline and at 26 weeks.
Data were collected using standardised data collection forms and questionnaires translated into national languages. Data collection included the candidate inclusion/exclusion criteria items for classification of PMR, physical examination and assessment of corticosteroid response. Criteria items were age 50 years or older, symptom duration 2 weeks or more, bilateral shoulder and/or pelvic girdle aching, recent weight loss greater than 2 kg, duration of morning stiffness more than 45 min, elevated buy canada goose jacket cheap ESR, elevated CRP and rapid response of symptoms to corticosteroids (>75% global response within 1 week to prednisolone/prednisone 15 20 mg a day). Pain was assessed using a horizontal 100 mm visual analogue scale (VAS) in four separate locations (shoulder, pelvic, neck and overall) with zero indicating no pain canada goose outlet and 100 indicating worst pain. Morning stiffness (in the past 24 h) was assessed in minutes; functional status and quality of life were assessed by the modified health assessment questionnaire (MHAQ) and short form 36. A 100 mm VAS was also used for recording global wellbeing measures (patient and physician global) and fatigue. Physical examination included the presence or absence of tenderness, pain on movement and limitation of the shoulders and hips. Aspects of corticosteroid therapy including dose, therapeutic response and change in dose and therapy discontinuation were documented.
canada goose uk outlet Data regarding laboratory measures (including ESR, CRP, rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA)) were obtained from clinically ordered tests performed at each study centre. As the laboratory assays used at each centre varied, test results were classified as normal/abnormal using the reference ranges from each centre (see supplementary appendix table S1, available online only). Both PMR and non PMR subjects underwent ultrasound evaluation of shoulders and hips at baseline and at 26 weeks. Evaluations were made according to EULAR guidelines28 to assess for features previously reported to be associated with PMR, including bicipital tenosynovitis, subacromial and subdeltoid bursitis, trochanteric bursitis and glenohumeral and hip effusion. Demographics (age and gender) and candidate criteria were compared between PMR and comparison subjects using 2 and rank sum tests. Several statistical approaches were considered in order to develop a scoring algorithm for PMR and to assess the proposed classification criteria in patients judged by expert clinician investigators to have PMR 26 weeks after enrolment.29 canada goose uk outlet
Canada Goose online First, logistic regression canada goose coats models to distinguish PMR patients from all comparison subjects and each subset of comparison subjects were examined. The c statistic, a measure of concordance analogous to the area under the receiver operating characteristic curve, was used to assess the ability of each individual criterion to distinguish between PMR and comparison subjects. The c statistic ranges from 0.5 to 1, with 0.5 indicating a criterion that provides no information. The sensitivity, specificity and the positive and negative likelihood ratios were also examined. Canada Goose online
canada goose coats Second, exploratory factor analysis was used to examine the interdependencies between the candidate criteria.30 Maximum likelihood factor analysis with varimax rotation was used. Maximum likelihood tests were used to examine goodness of fit (eg, to determine the number of factors). This method is thought to be superior to the eigenvalue greater than 1 or Catell’s scree plot method for selecting the number of factors.30 For each factor, variables with factor loadings greater than 0.5 were examined and found to represent a similar domain. This technique allowed a reduction of the number of variables, as one variable from each factor was examined in multivariable logistic regression models. In addition, to avoid discarding a relevant domain as identified by expert consensus, a few of the variables with factor loading between 0.4 and 0.5 were also considered in the multivariable models canada goose coats.