EULAR rheumatology open · 2026
Systematic literature review informing the 2025 EULAR recommendations for the management of polymyalgia rheumatica and primary large vessel vasculitis: focus on referral and diagnosis.
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Bartoletti Alice, Dey Mrinalini, Misra Durga Prasanna, Monti Sara, Ducker Georgina, Losasso John, Studenic Paul, Hellmich Bernhard, Mukhtyar Chetan B, Nikiphorou Elena, EULAR taskforce for the 2025 EULAR recommendations for the management of PMR and primary LVV
Аннотация
OBJECTIVES: This study aimed to systematically review the literature on polymyalgia rheumatica (PMR) and large vessel vasculitis (LVV) referral and diagnosis to inform the 2025 European Alliance of Associations for Rheumatology recommendations on the management of PMR and primary LVV.
METHODS: A systematic literature review focused on referral and diagnosis of PMR, giant cell arteritis (GCA), and Takayasu arteritis (TAK) was conducted across MEDLINE, Embase, and Cochrane for randomised trials, observational studies, and systematic reviews published from April 1, 2014 for PMR, and January 1, 2018 for LVV, to 31 December, 2024.
RESULTS: Forty-one studies were included, all of which were observational. Fast-track clinics for suspected PMR shortened the time to diagnosis (80-53 days and 12-7 days, 2 studies, P = .001) and hospitalisations (20%-3.5%, P = .001). PMR-like symptoms with covert LVV at imaging were associated with a higher relapse risk compared with isolated PMR (odds ratio: 6.99, 95% CI: 2.30-21.74) and required more glucocorticoids (prednisone equivalents dose at 12 months 7.5 ± 13.5 mg/d vs 2.4 ± 3.4 mg/d, P = .016) and disease-modifying antirheumatic drugs (conventional synthetic 50% vs 13%, P = .001; biological 28% vs 2%, P = .001). Multimodal diagnostic approaches integrating clinical and laboratory assessment, imaging, and/or temporal artery biopsy accurately diagnosed GCA (sensitivity 92%-99%, negative predictive value 85%-99%). No evidence emerged concerning TAK referral and diagnosis.
CONCLUSIONS: Initial evidence on fast-track clinics emerged in PMR. Subclinical LVV with PMR-like presentation is increasingly recognised, but its long-term prognosis remains unclear. The value of multimodal diagnostic approaches has been shown in GCA; studies are lacking in TAK and PMR.
METHODS: A systematic literature review focused on referral and diagnosis of PMR, giant cell arteritis (GCA), and Takayasu arteritis (TAK) was conducted across MEDLINE, Embase, and Cochrane for randomised trials, observational studies, and systematic reviews published from April 1, 2014 for PMR, and January 1, 2018 for LVV, to 31 December, 2024.
RESULTS: Forty-one studies were included, all of which were observational. Fast-track clinics for suspected PMR shortened the time to diagnosis (80-53 days and 12-7 days, 2 studies, P = .001) and hospitalisations (20%-3.5%, P = .001). PMR-like symptoms with covert LVV at imaging were associated with a higher relapse risk compared with isolated PMR (odds ratio: 6.99, 95% CI: 2.30-21.74) and required more glucocorticoids (prednisone equivalents dose at 12 months 7.5 ± 13.5 mg/d vs 2.4 ± 3.4 mg/d, P = .016) and disease-modifying antirheumatic drugs (conventional synthetic 50% vs 13%, P = .001; biological 28% vs 2%, P = .001). Multimodal diagnostic approaches integrating clinical and laboratory assessment, imaging, and/or temporal artery biopsy accurately diagnosed GCA (sensitivity 92%-99%, negative predictive value 85%-99%). No evidence emerged concerning TAK referral and diagnosis.
CONCLUSIONS: Initial evidence on fast-track clinics emerged in PMR. Subclinical LVV with PMR-like presentation is increasingly recognised, but its long-term prognosis remains unclear. The value of multimodal diagnostic approaches has been shown in GCA; studies are lacking in TAK and PMR.