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Polymyalgia rheumatica (PMR) is a diagnostic limbo. If a patient is evaluated by an experienced clinician who records the usual set of signs and symptoms along with the pertinent increased inflammatory markers, the diagnosis is usually correct. However, in several instances, PMR may evolve or transform into elderly onset rheumatoid arthritis (EORA), a switch that cannot be easily predicted and is usually recognized only during followup1. When less experienced clinicians are involved, overdiagnosis and underdiagnosis of PMR are relatively frequent because several conditions may mimic the disease, and a gold standard for diagnosis confirmation is lacking.The availability of the recent American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria is expected to improve PMR classification2. Clinicians may also be enticed to apply these criteria in the individual patient although, as widely stated3, criteria should be used for classification only. The multifaceted essence of PMR may account for the wide range of its clinical presentations, making it difficult to identify a 1-size-fits-all set of criteria.In this issue of The Journal , Ozen, et al 4 describe a multicenter study dealing with the comparison of different sets of PMR classification criteria, including the ACR/EULAR criteria. The main findings of this study, which confirmed the overall good performance of the criteria, are that they are not optimal in differentiating PMR from seronegative polyarthritis and that, if a cutoff for laboratory inflammation is included, performance can increase. By comparing the existing sets of criteria, several studies from the literature obtained different results (Table 12,4,5,6,7,8,9). In Ozen’s study, the new ACR/EULAR criteria showed a moderate-to-good discriminating capacity between PMR and non-PMR. However, the best performance was obtained by the Chuang, … Address correspondence to Dr. D. Camellino, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy. E-mail: dario.camel{at}gmail.com

Are the New ACR/EULAR Criteria the Ultimate Answer for Polymyalgia Rheumatica Classification?