2015 Recommendations for the Management of Polymyalgia Rheumatica

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 antirheumatic drugs (DMARDs), as well as the roles of nonsteroidal 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. Internal Medicine and Rheumatology, Warsaw, Poland; Peter Balint, MD, PhD: National Institute of Rheumatology and Physiotherapy, 3rd Rheumatology Department, Budapest, Hungary; Kevin Barraclough, FRCP, MRCGP: Hoyland House, Painswick, UK; Lina Bianconi, MD: Bibbiano, Italy; Frank Buttgereit, MD: Charit e University Medicine, Department of Rheumatology, Berlin, Germany; Steven Carsons, MD: Stony Brook University School of Medicine, Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital Campus, Mineola, New York; Daniel Ching, MBChB, FRCP, FRACP: Timaru Hospital, Department of Rheumatology, Timaru, New Zealand; Maria Cid, MD: University of Barcelona Hospital Clinic, Department of Systemic Autoimmune Diseases, Barcelona, Spain; Andreas Diamantopoulos, MD, PhD: Hospital of Southern Norway Trust, Department of Rheumatology, Kristiansand, Norway; William Docken, MD: Brigham and Women’s Hospital, Division of Rheumatology, Boston, Massachusetts; Christina Duftner, MD, PhD, Michael Schirmer, MD: Medical University of Innsbruck, Department of Internal Medicine—Clinic VI, Innsbruck, Austria; Kate Gilbert, Pamela Hildreth, Jean Miller, Lorna Neill, Jennifer Nott, Hannah Padbury: patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK; David Jayne, MD, FRCP: University of Cambridge, Department of Medicine, Cambridge, UK; Manuella Lima, MD: Hospital Universit ario Pedro Ernesto, Department of Rheumatology, Rio de Janeiro, Brazil; Ajesh Maharaj, MBBS: University of Kwa Zulu Natal, Prince Mshiyeni Memorial Hospital, Nelson R. Mandela School of Medicine, Department of Internal Medicine, Durban, South Africa; Christian Mallen, MRCGP, PhD: Keele University, Arthritis Research UK Primary Care Centre, Keele, UK; Victor Martinez-Taboada, MD, PhD: Universidad de Cantabria, Hospital Universitario Marqu es de Valdecilla, Facultad de Medicina, Servicio de Reumatolog ıa, Santander, Spain; Mehrdad Maz, MD: University of Kansas Medical Center, Department of Medicine, Division of Allergy, Clinical Immunology, and Rheumatology, Kansas City; Steven Merry, MD: Mayo Clinic, Department of Family Medicine, Rochester, Minnesota; Shunsuke Mori, MD, PhD: NHO Kumamoto Saishunsou National Hospital, Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, Kohshi, Kumamoto, Japan; Elisabeth Nordborg, MD: Sahlgren University Hospital, Department of Rheumatology, G€ oteborg, Sweden; Carlo Salvarani, MD: Azienda Ospedaliera-IRCCS di Reggio Emilia, Department of Internal Medicine, Division of Rheumatology, Reggio Emilia, Italy; Wolfgang Schmidt, MD: Immanuel Krankenhaus Berlin and Medical Center for Rheumatology Berlin–Buch, Berlin, Germany; Robert Spiera, MD: Hospital for Special Surgery, Department of Medicine, New York, New York; David Tronnier: patient representative from the Mayo Clinic, Rochester, Minnesota; Alexandre Wagner, MD, PhD: Universidade Federal de S~ao Paulo, Department of Internal Medicine, S~ao Paulo, Brazil; Eric L. Matteson, MD, MPH: Mayo Clinic College of Medicine, Department of Health Sciences Research, Division of Rheumatology, Rochester, Minnesota. Drs. Matteson and Dasgupta contributed equally to this work. Dr. Dejaco has received consulting fees, speaking fees, and/ or honoraria from Bristol-Myers Squibb, Pfizer, AbbVie, MSD, Merck Serono, and Roche, and research funding from Pfizer and MSD. Dr. Mackie has received consulting fees, speaking fees, and/or honoraria from Pfizer, Napp Pharmaceuticals, and AstraZeneca. Dr. Bachta has received consulting fees, speaking fees, and/or honoraria from Medac, Abbott, ENEL-MED, Wyeth, and Lilly, and research funding from Wyeth and Lilly. Dr. Balint has received consulting fees, speaking fees, and/or honoraria from Pfizer, SonoSite, and Abbott, and research funding from Abbott and Bristol-Myers Squibb. Dr. Buttgereit has received consulting fees, speaking fees, and/or honoraria from Merck Serono, Horizon Pharma, and Mundipharma, and research funding from Merck Serono and Horizon Pharma. Dr. Carsons has received consulting fees, speaking fees, and/or honoraria from Centocor. Dr. Cid has received consulting fees, speaking fees, and/or honoraria from Centocor, Roche, and Bristol-Myers Squibb. Dr. Cimmino has received consulting fees, speaking fees, and/or honoraria from Roche, Bristol-Myers Squibb, and Menarini, and research funding from Roche. Dr. Duftner has received consulting fees, speaking fees, and/or honoraria from Bristol-Myers Squibb, Pfizer, AbbVie, MSD, Merck Serono, and Roche. Dr. Jayne has received consulting fees, speaking fees, and/or honoraria from Roche/Genentech, and research funding from the company. Dr. Maharaj has received consulting fees, speaking fees, and/or honoraria from AstraZeneca and Pfizer. Dr. Martinez-Taboada has received consulting fees, speaking fees, and/or honoraria from UCB Pharma, Pfizer, Cellerix, and Abbott, and research funding from Roche. Dr. Mori has received research funding from Bristol-Myers Squibb. Dr. Salvarani has received consulting fees, speaking fees, and/or honoraria from Novartis. Dr. Schirmer has received consulting fees, speaking fees, and/or honoraria from Abbott, Pfizer, Amgen, GlaxoSmithKline, and MSD. Dr. Schmidt has received consulting fees, speaking fees, and/or honoraria from Berlin-Chemie, Medac, Pfizer, AbbVie, Roche, Mundipharma, UCB, and MSD, and research funding from Mundipharma, Novartis, MJD Pharmaceutical, Actelion, General Electric, Esadie, and Savient. Dr. Spiera has received research funding from Roche/Genentech. Dr. Matteson has received research funding from Ardea, Sanofi, Centocor/Janssen, Celgene, Amgen, Roche, Genentech, Mesoblast, Novartis, Pfizer, and UCB Pharma. Dr. Dasgupta has received consulting fees, speaking fees, and/or honoraria from Merck and research funding from Roche, Mundipharma, and Servier. Address correspondence to Bhaskar Dasgupta, MD, FRCP, Department of Rheumatology, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, UK. E-mail: [email protected]. Submitted for publication February 20, 2015; accepted in revised form July 13, 2015. 2570 DEJACO ET AL