Background
Author | Country; survey type; age threshold | GCA and PMR prevalence | Classification |
---|---|---|---|
Kyle et al. 1985 [5] | UK; GP practice based survey; ≥ 65 years. | GCA: 1.23 % (95 % CI 0.38 to 2.08) PMR: 1.69 % (95 % CI 0.70 to 2.68) | GCA: Jones and Hazleman PMR: Jones and Hazleman |
Koboyashi et al. 2003 [20] | Japan; Hospital only treated patients in 1997; ≥50 years | GCA: 0.002 % | GCA: ACR 1990 |
Lawrence et al. 2008 [7] Salvarni et al., 1999 [8]. Doran et al. 2002 [9]. | USA; Olmsted County survey of cumulative incidence 1950–1999; ≥50 years | GCA: 0.28 % (95 % CI, 0.19–0.27) - PMR: 0.74 % (95 % CI, 0.67–0.81) | GCA: ACR 1990 PMR: Doran et al. |
Mohammad et al. 2011 [21] | Skåne,Sweden; survey of cumulative incidence 1997 – 2010; ≥50 years | GCA: 0.11 % (95 % CI, 0.10–0.12). | GCA: Temporal artery biopsy positive only |
Herlyn et al. 2014 [10] | Germany; Survey of hospitals, private physicians and insurance companies in 2006; ≥50 years | GCA: 0.04 % (95 % CI 0.04 to 0.05) | GCA: ACR 1990 |
Salaffi et al. 2005 [24] | Italian MAPPING study; population survey; age ≥65 years | PMR: 0.37 % (95 % CI 0.29–0.44) | PMR: Bird et al. |
Bernatsky et al. 2009 [23] | Canada; hospital record survey, cumulative incidence 1995–2006; ≥50 years | PMR: 0.64 % (urban); 0.86 % (rural) | PMR: Physician billing twice within 2 months or stated on hospital discharge. |
Pamuk et al. 2009 [19] | Turkey. Single rheumatology department in a tertiary referral centre, cumulative incidence, ≥50 years | PMR and GCA: 0.02 % | GCA: ACR 1990 PMR: Chuang et al. |
Methods
Design
Setting
Database search
Case classification
GCA
PMR
Authors & Year | Proposed Criteria | Requirement for Classification |
---|---|---|
Bird et al. (1979) | Age ≥65 years Bilateral shoulder pain and stiffness; acute or subacute onset (<2 weeks); morning stiffness >1 h depression and/or weight loss; bilateral tenderness in upper arm muscles ESR >40 mm/h | Any three, or any one plus temporal artery abnormality (including decreased pulsation, tenderness, beading or bruit). |
Jones and Hazelman (1981) | Shoulder and pelvic girdle pain; morning stiffness >1 h; exclusion of rheumatoid arthritis or other inflammatory arthropathy, myopathy, malignancy ESR >30 mm/h or CRP >6 mg/L Rapid response to corticosteroids | All criteria must be met |
Chuang et al. (1982) | Age ≥50 years >1 month bilateral aching and stiffness of at least two of the following areas: Neck or torso, shoulders or proximal arms, hips or proximal thighs; exclusion of other causes ESR >40 mm/h | All criteria must be met |
Healey and Wilske (1984) | Age ≥ 50 years >1 month of neck, shoulder, or pelvic girdle pain (any two areas); morning stiffness >1 h; exclusion of other diagnoses ESR ≥40 mm/h Rapid response to daily, low-dose steroid therapy (i.e., prednisolone ≤20 mg) | All criteria must be met |
Doran et al. (2002) | Age ≥ 50 years; Bilateral aching and morning stiffness (lasting ≥ 30 min) persisting for at least 1 month and involving 2 of the following areas: neck or torso, shoulders or proximal regions of the arms, and hips or proximal aspects of the thighs ESR > 40 mm/h OR rapid response to corticosteroids | All criteria must be met |
Dasgupta et al. (2012) | Morning stiffness ≥ 45 min (2 points); Hip pain, limited range of movement (1 point) Absence of other joint pain (1 point) Normal RhF or ACPA (2 points) Ultrasound criteria: at least 1 shoulder with subdeltoid bursitis and/or biceps tenosynovitis and/or glenohumeral synovitis AND at least 1 hip with synovitis and/or trochanteric bursitis (1 point); both shoulders with subdeltoid bursitis, bicep tenosynovitis or glenohumeral synovitis (1 point) | All patients must be: Age ≥50 years, have bilateral shoulder aching and abnormal ESR/CRP Scoring algorithm without ultrasound score of 4 needed – with ultrasound score of 5 needed |
Sampling frame
Questionnaire development
Clinical review of potential cases
Sample size calculation
Analysis
Results
Database search
Survey
Characteristics | Total Population | Survey Pool | Survey Responders | PMR | GCA | ||
---|---|---|---|---|---|---|---|
Self –reported | Confirmed by GP | Self –reported | Confirmed by GP | ||||
Number ≥55 years | 5,159 | 4,728 | 2,277 | 83 | 73 | 15 | 9 |
Age in years (median) | 62.5 | 68.0 | 70.0 | 75.6 | 75.8 | 72.1 | 73.9 |
Percentage Female (%) | 52.2 | 53.6 | 52.0 | 70.0 | 67.4 | 78.6 | 71.5 |
Clinical features reported on questionnaire | |||||||
Headache (%) | 4.7 | 8.4 | 9.5 | 31.3 | 55.6 | ||
Jaw Pain (%) | 7.5 | 20.5 | 19.2 | 31.3 | 44.4 | ||
Visual Disturbance (%) | 19.8 | 22.9 | 24.7 | 37.5 | 44.4 | ||
Scalp Tenderness (%) | 7.8 | 15.7 | 6.2 | 56.3 | 88.9 | ||
Shoulder Pain (%) | 24.9 | 67.5 | 67.1 | 50 | 77.8 | ||
Myalgia (%) | 18.8 | 68.7 | 67.1 | 43.8 | 55.6 | ||
Unexplained Weight loss (%) | 4.2 | 12.1 | 11 | 31.3 | 55.6 | ||
Migraine with aura (%) | 15 | 14.6 | 16.7 | 18.8 | 11.1 | ||
No Symptoms (%) | 55.8 | 20.5 | 21.9 | 18.8 | 0 |
Clinical review of questionnaire respondents
Case classification
Prevalence estimates
Age | Na | Female | Male | PMR | Female | Male | GCA | Female | Male | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | Pr (95 % CI) | N | Pr (95 % CI) | N | Pr (95 % CI) | N | Pr (95 % CI) | N | Pr (95 % CI) | N | Pr (95 % CI) | ||||
55–60 | 978 | 500 | 478 | 1 | 0.10 (0.00, 0.30) | 1 | 0.20 (0.00, 0.59) | 0 | 1 | 0.10 (0.00, 0.30) | 0 | 1 | 0.21 (0.00, 0.62) | ||
60–69 | 1902 | 989 | 913 | 20 | 1.05 (0.59, 1.51) | 15 | 1.52 (0.76, 2.28) | 5 | 0.55 (0.07, 1.03) | 3 | 0.16 (0.00, 0.34) | 3 | 0.30 (0.00, 0.65) | 0 | |
70–79 | 1412 | 700 | 712 | 49 | 3.47 (2.52, 4.43) | 33 | 4.71 (3.14, 6.28) | 16 | 2.25 (1.16, 3.33) | 6 | 0.43 (0.09, 0.76) | 4 | 0.57 (0.01, 1.13) | 2 | 0.28 (0.00, 0.67) |
80–89 | 695 | 395 | 300 | 40 | 5.76 (4.02, 7.49) | 20 | 5.06 (2.90, 7.22) | 20 | 6.67 (3.84, 9.49) | 9 | 1.30 (0.45, 2.14) | 5 | 1.27 (0.16, 2.37) | 4 | 1.33 (0.04, 2.63) |
90–100 | 166 | 116 | 50 | 7 | 4.22 (1.16, 7.27) | 5 | 4.31 (0.62, 8.01) | 2 | 4.00 (0.00, 9.43) | 2 | 1.72 (0.00, 4.09) | 2 | 1.72 (0.00, 4.09) | 0 | |
100+ | 6 | 6 | 0 | 0 | N/A | N/A | 0 | N/A | N/A | ||||||
Total | 5159 | 2706 | 2453 | 117 | 2.27 (1.86, 2.67) | 74 | 2.74 (21.12, 3.35) | 43 | 1.75 (1.23, 2.27) | 21 | 0.41 % (0.23, 0.58) | 14 | 0.52 (0.25, 0.79) | 7 | 0.29 (0.07, 0.50) |
Criteria set | All | Female | Male | |||
---|---|---|---|---|---|---|
N | Pr (95 % CI) | N | Pr (95 % CI) | N | Pr (95 % CI) | |
GCA (21 cases reported in GP records) | ||||||
Hunder | 13 | 0.25 (0.11, 0.39) | 9 | 0.33 (0.12, 0.55) | 4 | 0.16 (0.00, 0.32) |
PMR (117 cases reported in GP records) | ||||||
Bird | 47 | 0.91 (0.65, 1.17) | 28 | 1.04 (0.65, 1.42) | 19 | 0.78 (0.43, 1.12) |
Healey; Chuang; Doran | 62 | 1.20 (0.90, 1.50) | 39 | 1.44 (0.99, 1.89) | 23 | 0.94 (0.56, 1.32) |
Jones and Hazleman | 79 | 1.53 (1.20, 1.87) | 49 | 1.81 (1.31, 2.31) | 30 | 1.22 (0.79, 1.66) |