Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (9 page)

   Antiphospholipid antibodies have been reported in patients with MCTD, with a lower frequency than that found in SLE. Anticardiolipin antibodies (ACAs) are present in approximately 15% of MCTD patients.

   Elevated ESR and CRP.

   Positive RF and anti-CCP antibodies in approximately 50% of the patients.

   Anemia, leukopenia, and hypergammaglobulinemia may present.

Suggested Reading

Ortega-Hernandez OD, Shoenfeld Y. Mixed connective tissue disease: an overview of clinical manifestations, diagnosis and treatment.
Best Pract Res Clin Rheumatol.
2012;26(1):61–72.

POLYMYALGIA RHEUMATICA

   Definition

   Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder characterized by morning stiffness and pain in the muscles of the shoulders, neck, back, hip, and thighs.

   The 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for PMR use a scoring algorithm that applies to patients >50 years of age, presenting with new bilateral shoulder pain (not better explained by an alternative diagnosis) and elevated CRP/ESR. The elements of this algorithm include the following:

   Morning stiffness for more than 45 minutes (2 points)

   Hip pain/ limited range of motion (1 point)

   Absence of rheumatoid factor and/or anti–citrullinated protein antibody (2 points)

   Absence of peripheral joint pain (1 point)

   A score of 4 or more has 68% sensitivity and 78% specificity for distinguishing PMR patients. Ultrasound findings of bilateral shoulder abnormalities or abnormalities in one shoulder and hip were found to significantly improve both sensitivity and specificity of the clinical criteria.

   Who Should Be Suspected?