title: Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica.
abstract: OBJECTIVE
  To evaluate the impact of polymyalgia rheumatica (PMR) on clinical outcomes and quality of life (QOL); the relationship between laboratory measures and clinical outcomes, and changes in QOL; and agreement between rheumatologists in confirming the initial diagnosis.
  
  
  METHODS
  We conducted a prospective study of 129 participants in 8 hospitals in England who met a modified version of the Jones and Hazleman criteria and had not started steroid therapy. The main outcome measures were response to steroids after 3 weeks (minimum 50% improvement in proximal pain, morning stiffness <30 minutes, acute-phase response not elevated), relapses, QOL as measured by the Short Form 36 and Health Assessment Questionnaire, and diagnosis reassessment at 1 year.
  
  
  RESULTS
  At 3 weeks, 55% of participants failed to meet our definition of a complete response to steroid therapy. Both physical and mental QOL at presentation were substantially lower than general population norms and improved by 12.6 (95% confidence interval [95% CI] 10.8, 14.4) and 11.2 (95% CI 8.5, 13.8) points, respectively, at 1 year. Proximal pain and longer morning stiffness were significantly associated with lower physical QOL during followup, whereas erythrocyte sedimentation rate was most strongly associated with lower mental QOL during followup. There was moderate agreement between clinicians in confirming the PMR diagnosis (kappa coefficients 0.49-0.65).
  
  
  CONCLUSIONS
  PMR is a heterogeneous disease with a major impact on QOL. Ongoing monitoring should include disease activity based on symptoms, emergence of alternative diagnoses, and early referral of atypical and severe cases.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hutchings
authors.forename: Jane
authors.initials: J
authors.lastname: Hollywood
authors.forename: Donna L
authors.initials: DL
authors.lastname: Lamping
authors.forename: Colin T
authors.initials: CT
authors.lastname: Pease
authors.forename: Kuntal
authors.initials: K
authors.lastname: Chakravarty
authors.forename: Barbara
authors.initials: B
authors.lastname: Silverman
authors.forename: Ernest H S
authors.initials: EH
authors.lastname: Choy
authors.forename: David G I
authors.initials: DG
authors.lastname: Scott
authors.forename: Brian L
authors.initials: BL
authors.lastname: Hazleman
authors.forename: Brian
authors.initials: B
authors.lastname: Bourke
authors.forename: Nagui
authors.initials: N
authors.lastname: Gendi
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Dasgupta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001799:Blood Sedimentation; D005260:Female; D006304:Health Status; D006801:Humans; D007596:Joints / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D010147:Pain Measurement; D011111:Polymyalgia Rheumatica / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone