title: 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.
abstract: 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.
authors.affiliation: Department of Rheumatology, Medical University Graz, Graz, Austria Department of Rheumatology, Southend University Hospital, Southend, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Dejaco
authors.affiliation: Department of Rheumatology, Southend University Hospital, Southend, UK.
authors.forename: Yogesh P
authors.initials: YP
authors.lastname: Singh
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Pablo
authors.initials: P
authors.lastname: Perel
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hutchings
authors.affiliation: Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, University of Genova, Genoa, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Camellino
authors.affiliation: University of Leeds, NIHR-Leeds Musculoskeletal Biomedical Research Unit and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mackie
authors.affiliation: Department of Rheumatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Abril
authors.affiliation: Department of Internal Medicine and Rheumatology, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Artur
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authors.lastname: Bachta
authors.affiliation: 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
authors.forename: Peter
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authors.lastname: Balint
authors.affiliation: Hoyland House General Practice, Painswick, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Barraclough
authors.affiliation: General Practice, Bibbiano, Italy.
authors.forename: Lina
authors.initials: L
authors.lastname: Bianconi
authors.affiliation: Department of Rheumatology, Charitè University Medicine, Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Buttgereit
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital Campus, Stony Brook University School of Medicine, Mineola, New York, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Carsons
authors.affiliation: Department of Rheumatology, Timaru Hospital, Timaru, New Zealand.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ching
authors.affiliation: Department of Systemic Autoimmune Diseases, University of Barcelona, Hospital Clinic, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Cid
authors.affiliation: Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, University of Genova, Genoa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cimmino
authors.affiliation: Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.
authors.forename: Andreas
authors.initials: A
authors.lastname: Diamantopoulos
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: William
authors.initials: W
authors.lastname: Docken
authors.affiliation: Department of Internal Medicine-Clinic VI, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Christina
authors.initials: C
authors.lastname: Duftner
authors.affiliation: Department of Rheumatology, Southend University Hospital, Southend, UK.
authors.forename: Billy
authors.initials: B
authors.lastname: Fashanu
authors.affiliation: Patient Representative from PMRGCAuk, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Gilbert
authors.affiliation: Patient Representative from PMRGCAuk, UK.
authors.forename: Pamela
authors.initials: P
authors.lastname: Hildreth
authors.affiliation: Department of Rheumatology, Southend University Hospital, Southend, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Hollywood
authors.affiliation: Department of Medicine, University of Cambridge, Cambridge, UK.
authors.forename: David
authors.initials: D
authors.lastname: Jayne
authors.affiliation: Department of Rheumatology, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil.
authors.forename: Manuella
authors.initials: M
authors.lastname: Lima
authors.affiliation: Department of Internal Medicine, University of Kwa Zulu Natal, Prince Mshiyeni Memorial Hospital, Nelson R Mandela School of Medicine, Durban, South Africa.
authors.forename: Ajesh
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authors.lastname: Maharaj
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Mallen
authors.affiliation: Facultad de Medicina, Servicio de Reumatología, Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Martinez-Taboada
authors.affiliation: Department of Medicine, Division of Allergy, Clinical Immunology, and Rheumatology, The University of Kansas Medical Center Kansas City, Kansas, USA.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Maz
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Merry
authors.affiliation: Patient Representative from PMRGCAuk, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Miller
authors.affiliation: Department of Rheumatology, NHO Kumamoto Saishunsou National Hospital, Clinical Research Center for Rheumatic Diseases, Kohshi, Kumamoto, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Mori
authors.affiliation: Patient Representative from PMRGCAuk, UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: Neill
authors.affiliation: Department of Rheumatology, Sahlgren University Hospital, Göteborg, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Nordborg
authors.affiliation: Patient Representative from PMRGCAuk, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nott
authors.affiliation: Patient Representative from PMRGCAuk, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Padbury
authors.affiliation: University of Leeds, NIHR-Leeds Musculoskeletal Biomedical Research Unit and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Pease
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Azienda Ospedaliera-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
authors.affiliation: Department of Internal Medicine-Clinic VI, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Schirmer
authors.affiliation: Immanuel Krankenhaus Berlin: Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schmidt
authors.affiliation: Department of Medicine, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Spiera
authors.affiliation: Patient Representative from the USA.
authors.forename: David
authors.initials: D
authors.lastname: Tronnier
authors.affiliation: Department of Internal Medicine, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Department of Rheumatology, Southend University Hospital, Southend, UK.
authors.forename: Madeline
authors.initials: M
authors.lastname: Whitlock
authors.affiliation: Department of Health Sciences Research, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.affiliation: Department of Rheumatology, Southend University Hospital, Southend, UK.
authors.forename: Bhaskar
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authors.lastname: Dasgupta
mesh_terms: D000465:Algorithms; D018501:Antirheumatic Agents / Q000627:therapeutic use; D035843:Biomedical Research / Q000379:methods; D019468:Disease Management; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000379:methods; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007391:International Cooperation; D008517:Phytotherapy / Q000379:methods; D011111:Polymyalgia Rheumatica / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids
keywords: Corticosteroids; Giant Cell Arteritis; Patient perspective; Polymyalgia Rheumatica; Treatment