diagnostic criteria for polymyalgia rheumatica (PMR)

Last reviewed 05/2021

This diagnostic criteria should be applied in:

  • patients aged 50 years or older presenting with new-onset (<12 weeks) bilateral shoulder pain and abnormal acute-phase response (elevated CRP and/or ESR)

The criteria may only be applied to those patients in whom the symptoms are not better explained by an alternative diagnosis.

Four clinical and laboratory criteria along with optional ultrasound criteria can be applied to eligible patients to identify patients with PMR suitable for low-dose corticosteroid therapy

  • the scoring scale is 0-6 (without ultrasound) and 0-8 (with ultrasound)
  • in the absence of competing diagnoses, a score of 4 or greater (without ultrasound), or 5 or greater (with ultrasound) is indicative of PMR
  • patients with a score of less than 4 (based on clinical plus laboratory criteria) cannot be considered to have PMR
  • ultrasound improves the specificity of PMR diagnosis, and shows particularly good performance in differentiating PMR from noninflammatory conditions and thus is a recommended investigation for PMR.
  Points without ultrasound (US) (0-6) Points with US (0-8) *
Morning stiffness duration >45 minutes 2 2
Hip pain or limited range of motion 1 1
Absence of RF or ACPA 2 2
Absence of other joint involvement 1 1
At least 1 shoulder with subdeltoid bursitis and/or biceps tenosynovitis and/or glenohumeral synovitis (either posterior or axillary) and at least 1 hip with synovitis and/or trochanteric bursitis Not applicable 1
Both shoulders with subdeltoid bursitis, biceps tenosynovitis, or glenohumeral synovitis Not applicable 1

A score of 4 or more is categorized as polymyalgia rheumatica (PMR) in the algorithm without ultrasound (US) and a score of 5 or more is categorized as PMR in the algorithm with US. CRP = C-reactive protein; ESR = erythrocyte sedimentation rate; RF = rheumatoid factor; ACPA = anti-citrullinated protein antibody;

*Optional ultrasound criteria.