rheumatology

PMR Diagnostic Score (EULAR/ACR 2012)

Classifies polymyalgia rheumatica (PMR) using EULAR/ACR 2012 provisional classification criteria. Score >=4 (without US) or >=5 (with US) = PMR.

Required: age ≥ 50, new bilateral shoulder aching and abnormal CRP and/or ESR*

Morning stiffness lasting more than 45 minutes (+2)*

Hip pain or limited range of hip movement (+1)*

Rheumatoid factor and anti-CCP (ACPA) both negative (+2)*

Absence of other joint pain (+1)*

Ultrasound of shoulders and hips (optional)*

Ultrasound: ≥ 1 shoulder with subdeltoid bursitis, biceps tenosynovitis or glenohumeral synovitis AND ≥ 1 hip with synovitis or trochanteric bursitis (+1)

Yes

Ultrasound: both shoulders with subdeltoid bursitis, biceps tenosynovitis or glenohumeral synovitis (+1)

Yes

Score interpretation

Not Applicable — Required Criteria Not Met -1

The 2012 criteria apply only to people aged 50 or over with new bilateral shoulder aching and abnormal CRP and/or ESR.

→ Consider alternative diagnoses: RA (check RF, anti-CCP, joint X-rays), late-onset seronegative RA, malignancy, GCA, hypothyroidism, fibromyalgia, shoulder OA; rheumatology referral if uncertain

PMR Not Classified 0

Score below the cut-off: < 4 of 6 without ultrasound, or < 5 of 8 with ultrasound.

→ Consider alternative diagnoses: RA (check RF, anti-CCP, joint X-rays), late-onset seronegative RA, malignancy, GCA, hypothyroidism, fibromyalgia, shoulder OA; rheumatology referral if uncertain

PMR Classified 1

Score at or above the cut-off: ≥ 4 of 6 without ultrasound, or ≥ 5 of 8 with ultrasound (2012 EULAR/ACR).

→ Confirm diagnosis clinically (bilateral shoulder pain, elevated ESR/CRP, age ≥50); prednisolone 15 mg daily and expect rapid response (48–72h); if no response in 1 week, reconsider diagnosis; monitor for GCA symptoms (headache, jaw claudication, visual symptoms); taper over 18–24 months; bone protection (bisphosphonate, calcium, vitamin D)

Interpretation bands for the PMR Score. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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