方法：分3个步骤制定风湿性多肌痛的分类标准。首先是由来自不同国家的27位风湿病专家对68项备选项目根据其重要性进行匿名投票，然后公布第一回合的投票结果，让这些专家重新投票，最后是针对在第2轮获得超过50%支持率的43项备选答案，让来自美国、加拿大、北欧及西欧的111位风湿病医生和53位非风湿科医生进行投票。

结果：第一轮和第二轮投票分别确认68项和50项备选项目，其中，第二轮投票中有43项获得至少超过50%的支持率，包括10项项目获得100%的支持。第三轮投票中，超过70%的调查者同意7项核心项目的重要性，这七项项目包括：（1）年龄大于50岁；（2）持续时间超过2周；（3）双侧肩和/骨盆带疼痛；（4）晨僵时间大于45分钟；（5）血沉增快；（6）CRP增高；（7）对激素疗效好（15-20mg/天的激素1周内获得75%以上总体反应）。体征方面，超过70%的调查者同意评估肩部（84%）及（和）髋部（76%）活动时疼痛和活动受限很重要性，但外周体征如腕管综合症、腱鞘炎和外周关节炎的支持率较低。

结论：本研究对制定风湿性多肌痛的分类标准很重要，下一步则要对有风湿性多肌痛症状的患者采用该候选分类标准进行国际前瞻性研究评价。

原文如下：

OBJECTIVE: This report summarizes the findings from a consensus process to identify potential classification criteria for polymyalgia rheumatica (PMR). METHODS: A 3-stage hybrid consensus approach was used to develop potential PMR classification criteria. The first stage consisted of a facilitated meeting of 27 international experts who anonymously rated the importance of 68 potential criteria. The second stage involved a meeting of the experts, who were provided with the results of the first round of ratings and were then asked to re-rate the criteria. In the third stage, the wider acceptance of the 43 criteria that received > 50% support at round 2 was evaluated using an extended mailed survey of 111 rheumatologists and 53 nonrheumatologists in the United States, Canada, and Northern and Western Europe. RESULTS: A total of 68 and 50 criteria were identified and rated in round 1 and round 2, respectively. In round 2, 43 of the 50 items achieved at least 50% support, including 10 core criteria achieving 100% support. In round 3, over 70% of survey respondents agreed on the importance of 7 core criteria. These were age >or=50 years, duration >or=2 weeks, bilateral shoulder and/or pelvic girdle aching, duration of morning stiffness > 45 min, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and rapid steroid response (> 75% global response within 1 wk to prednisolone/prednisone 15 -20 mg daily). Among physical signs, more than 70% of survey respondents agreed on the importance of assessing pain and limitation of shoulder (84%) and/or hip (76%) on motion, but agreement was low for peripheral signs like carpal tunnel, tenosynovitis, and peripheral arthritis. CONCLUSION: These findings make it important to develop classification criteria for PMR. The next step is to perform. an international prospective study to evaluate the utility of candidate classification criteria for PMR in patients presenting with the polymyalgic syndrome.

From:Dasgupta B, Salvarani C, Schirmer M,et al. Developing classification criteria for polymyalgia rheumatica: comparison of views from an expert panel and wider survey.J Rheumatol. 2008,35(2):270-7.