title: Contribution of the polymyalgia rheumatica activity score to glucocorticoid dosage adjustment in everyday practice.
abstract: OBJECTIVE
  To evaluate the usefulness of the polymyalgia rheumatica (PMR) activity score (PMR-AS) in guiding adjustment of glucocorticoid (GC) dosage.
  
  
  METHODS
  Rheumatologists prospectively included patients receiving GC therapy for PMR. At each visit, they assessed disease activity using a visual analog scale for physician's global assessment (VASph) and recorded whether a flare was diagnosed and/or the GC dosage was changed. In each patient, the PMR-AS was calculated using the formula of Leeb and Bird: C-reactive protein (mg/dl) + VAS pain score (0 to 10) + VASph (0 to 10) + (morning stiffness in min × 0.1) + elevation of upper limbs (0-3). We evaluated the correlation between PMR-AS and GC dosage changes in the group already treated with GC.
  
  
  RESULTS
  We included 89 patients (mean age 74.6 ± 6.2 yrs; disease duration 1.6 ± 2.2 yrs), who had a total of 149 visits. PMR-AS was available for 137 visits. Of those, 124 involved patients already treated with GC, and 13 patients who started GC treatment. The Spearman correlation coefficient between PMR-AS values and GC dosage change was 0.58 (p < 0.001). In the group already treated with GC, when the PMR-AS was higher than 20, GC dosages were never decreased. When the PMR-AS was between 10 and 20, GC dosages were decreased in 4 patients, unchanged in 4, and increased by < 5 mg in 4 patients. When PMR-AS was < 10, GC dosages were generally decreased.
  
  
  CONCLUSIONS
  The PMR-AS is helpful for diagnosing flares of PMR and may also assist in everyday practice to decide how to change the GC dosage.
authors.affiliation: Rheumatology Unit, Brest Teaching Hospital, Brest, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Cleuziou
authors.forename: Aymeric
authors.initials: A
authors.lastname: Binard
authors.forename: Michel
authors.initials: M
authors.lastname: De Bandt
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Berthelot
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011111:Polymyalgia Rheumatica / Q000175:diagnosis* / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D002097:C-Reactive Protein; D011241:Prednisone