FRI0653 Validity of polymyalgia rheumatica diagnoses, and classification criteria, in primary health care
Authors: C. Fors, U. Bergström, M. Willim, E. Pilman, C. Turesson
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Polymyalgia rheumatica (PMR) is an inflammatory disorder that mainly affects elderly women, and usually is diagnosed in primary health care (PHC). A number of classification criteria have been proposed, most recently the American College of Rheumatology (ACR)/ European League Against Rheumatism (EULAR) criteria from 2012 (1). The ACR/EULAR criteria were developed in a cohort of patients recruited from rheumatology clinics. <h3>Objectives:</h3> To examine the validity of PMR diagnoses in primary care, and to validate the use of classification criteria for PMR in a retrospective survey of a PHC cohort. <h3>Methods:</h3> Patients were recruited from two PHC centers. All patients with a registered diagnosis of PMR between 2000 and 2013 in the patient administrative system were identified. The electronic case records, including hospital records, for all patients were reviewed through June 2015. Patients with a diagnosis of PMR prior to 2000, or at another care facility, and those with an incorrectly registered PMR diagnosis code, were excluded. In a structured review of the case records, information required for classification according to the ACR/EULAR criteria, the Bird criteria, the Healey criteria, the Chuang&amp;Hunder criteria and the Jones&amp;Hazelman criteria was extracted. For the ACR/EULAR criteria, a modified version, in which patients who had never been tested for rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA) only required 2 points to be classified as having PMR, was used. Furthermore, as duration of morning stiffness (MS) was usually not recorded, criteria components for MS were considered to be fulfilled whenever MS was mentioned in the records. The reference method was an independent review, with assessment of the long term disease course and differential diagnoses, by an experienced rheumatologist with access to all electronic records. <h3>Results:</h3> A total of 305 patients with a registered diagnosis of PMR were reviewed. Of these, 117 were excluded. Among 188 with an incident PMR diagnosis at the study sites during the study period, 49 (26 %) fulfilled the modified ACR/EULAR criteria, whereas 145 (77 %) fulfilled the Bird criteria and 93 (49 %) fulfilled the Healey criteria. Patients could not be classified according to the Chuang&amp;Hunder or the Jones&amp;Hazelman criteria due to missing data in most patients for several components. RF and ACPA were tested in only 42 cases (4 positive) and 29 cases (none positive), respectively. The PMR diagnosis was verified using the reference method in 113 cases (60 % of total; 68 % female, mean age at diagnosis 75 years). Among those fulfilling the modified ACR/EULAR criteria, the diagnosis was verified in 84 % of the patients. The corresponding proportion for the Bird criteria was 66 %, and for the Healey criteria 74 %. <h3>Conclusions:</h3> In this study of patients with PMR diagnosed in PHC, the diagnosis could be verified in 60 % of the patients. This underlines the heterogeneity of PMR patients and related diagnostic procedures in PHC. A modified version of the ACR/EULAR criteria can be used to identify patients with a valid PMR diagnosis in retrospective surveys, but does not capture all PMR patients. The modified ACR/EULAR criteria appear to be more stringent than some of the older criteria sets. <h3>Reference</h3> 1. Dasgupta B, et al. Ann Rheum Dis2012;71:484–92. <h3>Disclosure of Interest:</h3> None declared