2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.
Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.
Medical University Graz, Department of Rheumatology, Graz, Austria, and Southend University Hospital, Department of Rheumatology, Essex, UK.
Christian
C
Dejaco
Southend University Hospital, Department of Rheumatology, Essex, UK.
Yogesh P
YP
Singh
London School of Hygiene and Tropical Medicine, Epidemiology and Population Health Faculty, London, UK.
Pablo
P
Perel
London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, UK.
Andrew
A
Hutchings
University of Genoa, Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, Genoa, Italy.
Dario
D
Camellino
University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.
Sarah
S
Mackie
Mayo Clinic, Department of Rheumatology, Jacksonville, Florida.
Andy
A
Abril
Military Institute of Medicine, Department of Internal Medicine and Rheumatology, Warsaw, Poland.
Artur
A
Bachta
National Institute of Rheumatology and Physiotherapy, 3rd Rheumatology Department, Budapest, Hungary.
Peter
P
Balint
Hoyland House, Painswick, UK.
Kevin
K
Barraclough
Bibbiano, Italy.
Lina
L
Bianconi
Charité University Medicine, Department of Rheumatology, Berlin, Germany.
Frank
F
Buttgereit
Stony Brook University School of Medicine, Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital Campus, Mineola, New York.
Steven
S
Carsons
Timaru Hospital, Department of Rheumatology, Timaru, New Zealand.
Daniel
D
Ching
University of Barcelona Hospital Clinic, Department of Systemic Autoimmune Diseases, Barcelona, Spain.
Maria
M
Cid
University of Genoa, Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, Genoa, Italy.
Marco
M
Cimmino
Hospital of Southern Norway Trust, Department of Rheumatology, Kristiansand, Norway.
Andreas
A
Diamantopoulos
Brigham and Women's Hospital, Division of Rheumatology, Boston, Massachusetts.
William
W
Docken
Medical University of Innsbruck, Department of Internal Medicine-Clinic VI, Innsbruck, Austria.
Christina
C
Duftner
Southend University Hospital, Department of Rheumatology, Essex, UK.
Billy
B
Fashanu
patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK.
Kate
K
Gilbert
patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK.
Pamela
P
Hildreth
Southend University Hospital, Department of Rheumatology, Essex, UK.
Jane
J
Hollywood
University of Cambridge, Department of Medicine, Cambridge, UK.
David
D
Jayne
Hospital Universitário Pedro Ernesto, Department of Rheumatology, Rio de Janeiro, Brazil.
Manuella
M
Lima
University of Kwa Zulu Natal, Prince Mshiyeni Memorial Hospital, Nelson R. Mandela School of Medicine, Department of Internal Medicine, Durban, South Africa.
Ajesh
A
Maharaj
Keele University, Arthritis Research UK Primary Care Centre, Keele, UK.
Christian
C
Mallen
Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Servicio de Reumatología, Santander, Spain.
Victor
V
Martinez-Taboada
University of Kansas Medical Center, Department of Medicine, Division of Allergy, Clinical Immunology, and Rheumatology, Kansas City.
Mehrdad
M
Maz
Mayo Clinic, Department of Family Medicine, Rochester, Minnesota.
Steven
S
Merry
patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK.
Jean
J
Miller
NHO Kumamoto Saishunsou National Hospital, Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, Kohshi, Kumamoto, Japan.
Shunsuke
S
Mori
patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK.
Lorna
L
Neill
Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden.
Elisabeth
E
Nordborg
patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK.
Jennifer
J
Nott
patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK.
Hannah
H
Padbury
University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.
Colin
C
Pease
Azienda Ospedaliera-IRCCS di Reggio Emilia, Department of Internal Medicine, Division of Rheumatology, Reggio Emilia, Italy.
Carlo
C
Salvarani
Medical University of Innsbruck, Department of Internal Medicine-Clinic VI, Innsbruck, Austria.
Michael
M
Schirmer
Immanuel Krankenhaus Berlin and Medical Center for Rheumatology Berlin-Buch, Berlin, Germany.
Wolfgang
W
Schmidt
Hospital for Special Surgery, Department of Medicine, New York, New York.
Robert
R
Spiera
patient representative from the Mayo Clinic, Rochester, Minnesota.
David
D
Tronnier
Universidade Federal de São Paulo, Department of Internal Medicine, São Paulo, Brazil.
Alexandre
A
Wagner
Southend University Hospital, Department of Rheumatology, Essex, UK.
Madeline
M
Whitlock
Mayo Clinic College of Medicine, Department of Health Sciences Research, Division of Rheumatology, Rochester, Minnesota.
Eric L
EL
Matteson
Southend University Hospital, Department of Rheumatology, Essex, UK.
Bhaskar
B
Dasgupta
D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D005060:Europe; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D011111:Polymyalgia Rheumatica / Q000188:drug therapy*; D012307:Risk Factors; D014481:United States
D018501:Antirheumatic Agents; D005938:Glucocorticoids