Reanalysis Of The Sensitivity And Specificity Of Various Classification Criteria For Rheumatic Polymyalgia

Objective: Rheumatic polymyalgia(PMR)is a common inflammatory rheumatic disease in the elderly population,treated with corticosteroids and characterised by pain and morning stiffness in the neck,shoulder girdle and buttocks,which may be accompanied by systemic manifestations such as fever,anaemia and weakness.Some patients with rheumatic polymyalgia often have a combination of giant cell arteritis(GCA).The lack of specific clinical manifestations,serological markers and imaging of rheumatic polymyalgia has made the diagnosis difficult.Since Bird proposed the first PMR classification in 1979 to the EULAR/ACR classification in 2012,there have been seven updates of the classification,but its sensitivity and specificity have been significantly deficient when applied in the clinical setting.In this study,the sensitivity and specificity of the seven PMR classification criteria published over the years were compared and analysed in order to improve the clinical differential diagnosis and correct diagnosis of PMR,and to provide a theoretical basis for the updating of the new PMR classification criteria.Methods: From January 2017 to June 2022,118 patients with PMR who were initially diagnosed and treated in the Department of Rheumatology and Immunology of Yiji Shan Hospital were selected,as well as 129 patients with non-PMR with similar PMR symptoms who were initially diagnosed and treated in the Department of Rheumatology and Immunology of Yiji Shan Hospital during the same period,including 82 patients with rheumatoid arthritis(RA),12 patients with systemic lupus erythematosus(SLE)There were 82 patients with rheumatoid arthritis(RA),12 with systemic lupus erythematosus(SLE),5 with dermatomyositis,4 with gout,3 with dry syndrome(SS),10 with spondyloarthropathy and 24 with frozen shoulder.Their general information(gender,age,disease duration,etc.),clinical manifestations,laboratory test results and imaging findings were collected separately.Statistical methods such as 2 test,Mann-Whitney U test and two independent samples t-test were used for analysis.Result:(1)Separate validation analyses were conducted for each of the seven criteria: Bird criteria had a sensitivity of 89.8% and specificity of45.7%;Jones and Hazleman criteria had a sensitivity of 31.4% and specificity of 85.3%;Chuang and Hunder criteria had a sensitivity of 33.1%and specificity of 100%;Healey criteria had a sensitivity of 70.3% and specificity of 63.6%;2008 International Consensus Classification Criteria had a sensitivity of 35.6% and specificity of 83.7%;2011 Chinese Medical Association The sensitivity of the Healey criteria was 70.3% and the specificity was 63.6%;the sensitivity of the 2008 International Consensus Classification Criteria was 35.6% and the specificity was 83.7%;the sensitivity of the 2011 Chinese Medical Association PMR Guidelines was63.6% and the specificity was 85.3%;the 2012 EULAR/ACR The sensitivity of the rheumatic polymyalgia classification criteria was 60.2% and the specificity was 82.9%.(2)Patients in the PMR group were statistically different from those in the non-PMR group in terms of clinical manifestations such as neck pain/restricted movement,bilateral pelvic girdle(hip)pain,hip pressure pain,restricted hip movement and other joint pain(P < 0.05),and the mean ESR(63.41 ± 26.87 mm/h)and CRP level(62.89 ± 136.47 mg/L)of patients in the PMR group were significantly higher than those of patients in the non-PMR group(P < 0.05).(3)By multifactor logistic regression analysis,neck pain or limitation of movement,bilateral pelvic girdle(hip)pain,limitation of hip movement,absence of other joint pain,and negative RF/ACPA could be used as predictive models for PMR.(4)On imaging,44 patients with PMR underwent ultrasound examinations of both shoulders and hips,of which 34 had biceps tenosynovitis and 28 had periprosthetic nodular bursitis with effusion.60 patients with PMR and 12 patients with frozen shoulder underwent MRI examinations of both shoulders,which showed that patients with PMR were more likely to have humeral head oedema or small cystic changes and distal supraspinatus or infraspinatus tendons than those with frozen shoulder.The difference was statistically significant(P < 0.05),whereas patients with periarthritis were more likely to develop soft tissue swelling and oozing in the rotator cuff space or fluid sac area,soft tissue swelling and oozing in the rotator cuff space and fluid around the long head of the biceps tendon,with a statistically significant difference(P < 0.05).Conclusion: 1.Combined sensitivity and specificity,the 2012EULAR/ACR classification criteria are superior to the Bird criteria,Jones/Hazleman criteria,the 2008 International PMR Consensus,and the2011 Chinese Medical Association PMR treatment criteria.2.the main clinical manifestations suggestive of PMR are(1)age ≥ 50 years;(2)elevated blood sedimentation and/or CRP;(3)Bilateral shoulder pain;(4)neck pain and/or limitation of movement;(5)bilateral pelvic girdle(hip)pain;(6)limitation of hip movement;(7)negative RF and/or anti-CCP antibodies;(8)no other joint pain.The diagnosis of PMR can be considered if items 1-3 are met and any 2 or more of items 4-8 are also met,with an estimated sensitivity of 94.9% and specificity of 78.3%.3.On imaging,if ultrasound of both shoulders and both hips shows biceps tendon tenosynovitis and/or periprosthetic nodular bursitis with effusion,or MRI of both shoulders shows humeral head edema or small cystic changes and distal supraspinatus or infraspinatus tendon Injury,combined with the clinical presentation,should be considered as a possible PMR.