Polymyalgia rheumatica in primary care: managing diagnostic uncertaintyBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5199 (Published 07 October 2015) Cite this as: BMJ 2015;351:h5199
All rapid responses
We thank Rammya Mathew and Ahmed Rashid for bringing attention to the uncertainty around diagnosis and management of PMR.
The symptoms that they describe in their example (bilateral shoulder stiffness and pain associated with constitutional upset) are the classic biomedical description of the illness. However, we have recently carried out a qualitative study with patients with PMR1 which highlighted that they often present their illness as a story of sub-acute onset of considerable functional impairment rather than focussing on localised symptoms. This can contribute to the diagnostic uncertainty and patients in our study emphasised the anxiety that this uncertainty causes.
We note with interest the suggestion that patients be asked to keep a diary of their symptoms. This is not something which, to our knowledge, is standard practice but it resonates with our sense that a patient reported outcome measure for PMR would be a valuable tool to aid in assessment of the condition. Currently there are no validated patient centred outcome measures for PMR for use in research or in clinical practice and in a condition where there is such heterogeneity and a fine balance to be struck between benefits and harms of steroid treatment, this seems to be a significant need.
1. Twohig H, Mitchell C, Mallen C, Adebajo A, Mathers N. “I suddenly felt I’d aged”: A qualitative study of patient experiences of polymyalgia rheumatica (PMR). Patient education and counselling. 2015;98:645-50.
Competing interests: No competing interests