Klassifikationskriterien und Methoden zur Erfassung der Krankheitsaktivität bei der Polymyalgia rheumatica

Zusammenfassung

Die korrekte Diagnose der Polymyalgia rheumatica (PMR) gehört zu den schwierigsten Aufgaben des Rheumatologen in der klinischen Praxis. Einerseits können andere Erkrankungen eine PMR imitieren, andererseits sind bisher keine spezifischen Marker zur Diagnose der Erkrankung verfügbar. Neben den empirisch entwickelten Klassifikations- und Diagnosekriterien nach Hunder, Healey und Bird sind seit 2012 neue ACR/EULAR Klassifikationskriterien für die PMR verfügbar. Deren wesentlichste Neuerung ist die Berücksichtigung des Rheumafaktors und der anti-cyclisch citrullinierten Peptid (CCP) Antikörper sowie des Ergebnisses der Ultraschalluntersuchung der Schultern und Hüften. Zur Messung der Krankheitsaktivität wurde der PMR Activity Score (PMR-AS) vorgeschlagen, der das C-reaktive Protein, die Schmerzbeurteilung durch den Patienten, die Krankheitsaktivitätseinschätzung durch den Arzt, die Morgensteifigkeit und die Fähigkeit der Elevation der Arme in einen Score kombiniert. Patienten-orientierte Outcome Parameter wurden für die PMR bisher nicht entwickelt. Die Wertigkeit von bildgebenden Verfahren (z. B. Ultraschall, Magnetresonanztomografie oder ¹⁸F-FDG-PET) zum Monitoring von PMR Patienten ist bislang nicht geklärt.

Abstract

The diagnosis of polymyalgia rheumatica is challenging. Several rheumatic and non-inflammatory conditions may mimic the disease and there is still no specific diagnostic marker available. In addition to the diagnostic and classification criteria published by Hunder, Healey and Bird that were all developed on the basis of clinical experience, ACR/EULAR proposed new classification criteria in 2012. These new criteria consider clinical factors, acute phase reactants and the rheumatoid factor/anti-cyclic citrullinierted peptide (CCP) antibodies as well as the result of ultrasound assessment of shoulders and hips. For the assessment of disease activity, the PMR Activity Score (PMR-AS) may be used combining the C-reactive protein, pain assessment by the patient, global assessment by the physician, morning stiffness and elevation of upper limb in a single measure. Patient reported outcome measures have not been developed for PMR. The value of imaging methods (such as ultrasound, magnetic resonance imaging, ¹⁸F-FDG-PET) for monitoring PMR patients has not been clarified so far.

Schlüsselwörter

Polymyalgia rheumatica - Diagnose - Klassifikation - Krankheitsaktivität

Key words

polymyalgia rheumatica - diagnosis - classification criteria - disease activity

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