Rheumatology International

, Volume 36, Issue 7, pp 897–904 | Cite as

Patient-reported outcomes in trials of patients with polymyalgia rheumatica: a systematic literature review

  • Annie Huang
  • Isabel CastrejonEmail author
Original Article - Observational Research


Patient-reported outcomes (PROs) are being increasingly recognized as important measures by rheumatologists. The objective of this review was to evaluate the frequency of use of PROs in studies of patients with polymyalgia rheumatica (PMR). A systematic literature search was performed in PubMed (up to April 2015) to identify any type of clinical studies reporting any type of PROs in patients with PMR. Articles were excluded if they did not include adults with PMR or did not report any PROs. Characteristics of each study such as study design, follow-up, treatment assessed if any, number of patients, mean age, gender, and a description of PROs used were collected to perform a descriptive analysis. From 118 initial studies captured, 28 articles met the predefined criteria, and 20 were finally included in this review. Ten studies (50 %) were randomized clinical trials (RCTs), and 8 (40 %) were cohorts. The most frequently reported domains were: pain (90 %), being the most frequent tool using a visual analogue scale; morning stiffness in minutes (85 %); and function (25 %), evaluated through the Health Assessment Questionnaire. Other domains such as patient global assessment, fatigue, quality of life, and anxiety and depression were infrequently reported. A larger proportion of PROs were included in cohorts in comparison with RCT. Pain and morning stiffness are the most frequently reported PROs. Other domains that may appear relevant for patients are infrequently reported, especially function.


Polymyalgia rheumatica Review Patient-reported outcomes Disease activity 


Compliance with ethical standards

Conflict of interest



  1. 1.
    Cimmino MA, Zaccaria A (2000) Epidemiology of polymyalgia rheumatica. Clin Exp Rheumatol 18:S9–S11PubMedGoogle Scholar
  2. 2.
    Gamez-Nava JI, Gonzalez-Lopez L, Davis P, Suarez-Almazor ME (1998) Referral and diagnosis of common rheumatic diseases by primary care physicians. Br J Rheumatol 37:1215–1219CrossRefPubMedGoogle Scholar
  3. 3.
    Proven A, Gabriel SE, O’Fallon WM, Hunder GG (1999) Polymyalgia rheumatica with low erythrocyte sedimentation rate at diagnosis. J Rheumatol 26:1333–1337PubMedGoogle Scholar
  4. 4.
    Narvaez J, Nolla-Sole JM, Clavaguera MT, Valverde-Garcia J, Roig-Escofet D (1999) Longterm therapy in polymyalgia rheumatica: effect of coexistent temporal arteritis. J Rheumatol 26:1945–1952PubMedGoogle Scholar
  5. 5.
    Gabriel SE, Sunku J, Salvarani C, O’Fallon WM, Hunder GG (1997) Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum 40:1873–1878. doi: 10.1002/1529-0131(199710)40:10<1873:AID-ART22>3.0.CO;2-V CrossRefPubMedGoogle Scholar
  6. 6.
    Dasgupta B, Borg FA, Hassan N, Barraclough K, Bourke B, Fulcher J, Hollywood J, Hutchings A, Kyle V, Nott J, Power M, Samanta A, Bsr, Bhpr Standards G, Audit Working G (2010) BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford) 49:186–190. doi: 10.1093/rheumatology/kep303a CrossRefGoogle Scholar
  7. 7.
    Matteson EL, Maradit-Kremers H, Cimmino MA, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Slott Jensen H, Poor G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Cantini F, Nannini C, Macchioni P, Pipitone N, Del Amo M, Espigol-Frigole G, Cid MC, Martinez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazelman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Marcus R, Gonter NJ, Maz M, Crowson CS, Dasgupta B (2012) Patient-reported outcomes in polymyalgia rheumatica. J Rheumatol 39:795–803. doi: 10.3899/jrheum.110977 CrossRefPubMedGoogle Scholar
  8. 8.
    Mackie SL, Arat S, da Silva J, Duarte C, Halliday S, Hughes R, Morris M, Pease CT, Sherman JW, Simon LS, Walsh M, Westhovens R, Zakout S, Kirwan JR (2014) Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR. J Rheumatol 41:819–823. doi: 10.3899/jrheum.131254 CrossRefPubMedGoogle Scholar
  9. 9.
    Dejaco C, Duftner C, Cimmino MA, Dasgupta B, Salvarani C, Crowson CS, Maradit-Kremers H, Hutchings A, Matteson EL, Schirmer M, International Work Group for PMR, Gca (2011) Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus. Ann Rheum Dis 70:447–453. doi: 10.1136/ard.2010.133850 CrossRefPubMedGoogle Scholar
  10. 10.
    Fries JF, Spitz PW, Young DY (1982) The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol 9:789–793PubMedGoogle Scholar
  11. 11.
    Pincus T, Summey JA, Soraci SA Jr, Wallston KA, Hummon NP (1983) Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum 26:1346–1353CrossRefPubMedGoogle Scholar
  12. 12.
    McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD (1994) The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 32:40–66CrossRefPubMedGoogle Scholar
  13. 13.
    Bird HA, Esselinckx W, Dixon AS, Mowat AG, Wood PH (1979) An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis 38:434–439CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Jones JG, Hazleman BL (1981) Prognosis and management of polymyalgia rheumatica. Ann Rheum Dis 40:1–5CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Chuang TY, Hunder GG, Ilstrup DM, Kurland LT (1982) Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. Ann Intern Med 97:672–680CrossRefPubMedGoogle Scholar
  16. 16.
    Nobunaga M, Yoshioka K, Yasuda M, Shingu M (1989) Clinical studies of polymyalgia rheumatica. A proposal of diagnostic criteria. Jpn J Med 28:452–456CrossRefPubMedGoogle Scholar
  17. 17.
    Leeb BF, Bird HA, Nesher G, Andel I, Hueber W, Logar D, Montecucco CM, Rovensky J, Sautner J, Sonnenblick M (2003) EULAR response criteria for polymyalgia rheumatica: results of an initiative of the European Collaborating Polymyalgia Rheumatica Group (subcommittee of ESCISIT). Ann Rheum Dis 62:1189–1194CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Leeb BF, Bird HA (2004) A disease activity score for polymyalgia rheumatica. Ann Rheum Dis 63:1279–1283. doi: 10.1136/ard.2003.011379 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lund B, Egsmose C, Jorgensen S, Krogsgaard MR (1987) Establishment of the relative antiinflammatory potency of deflazacort and prednisone in polymyalgia rheumatica. Calcif Tissue Int 41:316–320CrossRefPubMedGoogle Scholar
  20. 20.
    Di Munno O, Beghe F, Favini P, Di Giuseppe P, Pontrandolfo A, Occhipinti G, Pasero G (1989) Prevention of glucocorticoid-induced osteopenia: effect of oral 25-hydroxyvitamin D and calcium. Clin Rheumatol 8:202–207CrossRefPubMedGoogle Scholar
  21. 21.
    Di Munno O, Imbimbo B, Mazzantini M, Milani S, Occhipinti G, Pasero G (1995) Deflazacort versus methylprednisolone in polymyalgia rheumatica: clinical equivalence and relative antiinflammatory potency of different treatment regimens. J Rheumatol 22:1492–1498PubMedGoogle Scholar
  22. 22.
    Krogsgaard MR, Lund B, Johnsson B (1995) A longterm prospective study of the equipotency between deflazacort and prednisolone in the treatment of patients with polymyalgia rheumatica. J Rheumatol 22:1660–1662PubMedGoogle Scholar
  23. 23.
    Salvarani C, Cantini F, Olivieri I, Barozzi L, Macchioni L, Boiardi L, Niccoli L, Padula A, Pulsatelli L, Meliconi R (2000) Corticosteroid injections in polymyalgia rheumatica: a double-blind, prospective, randomized, placebo controlled study. J Rheumatol 27:1470–1476PubMedGoogle Scholar
  24. 24.
    Kreiner F, Galbo H (2010) Effect of etanercept in polymyalgia rheumatica: a randomized controlled trial. Arthritis Res Ther 12:R176. doi: 10.1186/ar3140 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Cimmino MA, Parodi M, Caporali R, Montecucco C (2006) Is the course of steroid-treated polymyalgia rheumatica more severe in women? Ann N Y Acad Sci 1069:315–321. doi: 10.1196/annals.1351.030 CrossRefPubMedGoogle Scholar
  26. 26.
    Calvo L, Pistone G, Arnone S, Colomba D, Amico S, Giacalone A, Vitale P, Nicosia C, Barone E, Scaglione R, Licata G, Corrao S (2010) Polymyalgia rheumatica and vertebral fractures: a 1-year pilot controlled study. Rheumatol Int 30:1245–1247. doi: 10.1007/s00296-010-1399-0 CrossRefPubMedGoogle Scholar
  27. 27.
    Mackie SL, Hughes R, Walsh M, Day J, Newton M, Pease C, Kirwan J, Morris M (2015) “An impediment to living life”: why and how should we measure stiffness in polymyalgia rheumatica? PLoS ONE 10:e0126758. doi: 10.1371/journal.pone.0126758 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    White DK, Wilson JC, Keysor JJ (2011) Measures of adult general functional status: SF-36 Physical Functioning Subscale (PF-10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in activities of daily living, Functional Independence Measure (FIM), and Osteoarthritis-Function-Computer Adaptive Test (OA-Function-CAT). Arthritis Care Res (Hoboken) 63(Suppl 11):S297–S307. doi: 10.1002/acr.20638 CrossRefGoogle Scholar
  29. 29.
    Kalke S, Mukerjee D, Dasgupta B (2000) A study of the health assessment questionnaire to evaluate functional status in polymyalgia rheumatica. Rheumatology (Oxford) 39:883–885CrossRefGoogle Scholar
  30. 30.
    Hutchings A, Hollywood J, Lamping DL, Pease CT, Chakravarty K, Silverman B, Choy EH, Scott DG, Hazleman BL, Bourke B, Gendi N, Dasgupta B (2007) Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica. Arthritis Rheum 57:803–809. doi: 10.1002/art.22777 CrossRefPubMedGoogle Scholar
  31. 31.
    Pincus T, Callahan LF, Sale WG, Brooks AL, Payne LE, Vaughn WK (1984) Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years. Arthritis Rheum 27:864–872CrossRefPubMedGoogle Scholar
  32. 32.
    Sokka T, Hakkinen A, Krishnan E, Hannonen P (2004) Similar prediction of mortality by the health assessment questionnaire in patients with rheumatoid arthritis and the general population. Ann Rheum Dis 63:494–497. doi: 10.1136/ard.2003.009530 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    van Tuyl LH, Boers M (2015) Patient-reported outcomes in core domain sets for rheumatic diseases. Nat Rev Rheumatol 11:705–712. doi: 10.1038/nrrheum.2015.116 CrossRefPubMedGoogle Scholar
  34. 34.
    Cimmino MA, Parodi M, Montecucco C, Caporali R (2011) The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity. BMC Musculoskelet Disord 12:94. doi: 10.1186/1471-2474-12-94 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Salvarani C, Macchioni P, Manzini C, Paolazzi G, Trotta A, Manganelli P, Cimmino M, Gerli R, Catanoso MG, Boiardi L, Cantini F, Klersy C, Hunder GG (2007) Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial. Ann Intern Med 146:631–639CrossRefPubMedGoogle Scholar
  36. 36.
    Catanoso MG, Macchioni P, Boiardi L, Pipitone N, Salvarani C (2007) Treatment of refractory polymyalgia rheumatica with etanercept: an open pilot study. Arthritis Rheum 57:1514–1519. doi: 10.1002/art.23095 CrossRefPubMedGoogle Scholar
  37. 37.
    Salvarani C, Cantini F, Niccoli L, Macchioni P, Consonni D, Bajocchi G, Vinceti M, Catanoso MG, Pulsatelli L, Meliconi R, Boiardi L (2005) Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum 53:33–38. doi: 10.1002/art.20901 CrossRefPubMedGoogle Scholar
  38. 38.
    Bird HA, Leeb BF, Montecucco CM, Misiuniene N, Nesher G, Pai S, Pease C, Rovensky J, Rozman B (2005) A comparison of the sensitivity of diagnostic criteria for polymyalgia rheumatica. Ann Rheum Dis 64:626–629. doi: 10.1136/ard.2004.025296 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Dasgupta B, Dolan AL, Panayi GS, Fernandes L (1998) An initially double-blind controlled 96 week trial of depot methylprednisolone against oral prednisolone in the treatment of polymyalgia rheumatica. Br J Rheumatol 37:189–195CrossRefPubMedGoogle Scholar
  40. 40.
    van der Veen MJ, Dinant HJ, van Booma-Frankfort C, van Albada-Kuipers GA, Bijlsma JW (1996) Can methotrexate be used as a steroid sparing agent in the treatment of polymyalgia rheumatica and giant cell arteritis? Ann Rheum Dis 55:218–223CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Krogsgaard MR, Thamsborg G, Lund B (1996) Changes in bone mass during low dose corticosteroid treatment in patients with polymyalgia rheumatica: a double blind, prospective comparison between prednisolone and deflazacort. Ann Rheum Dis 55:143–146CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Division of RheumatologyRush University Medical CenterChicagoUSA

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