Abstract：
OBJECTIVE: To perform a systematic literature review on definitions and instruments used to measure remission, relapse, and disease activity in polymyalgia rheumatica (PMR), to inform an OMERACT project to endorse instruments for these outcomes.
METHODS: A search of Pubmed/MEDLINE, EMBASE, CINAHL, Cochrane, and Epistemonikos was performed May 2021 and updated August 2023. Qualitative and quantitative studies published in English were included if they recruited people with isolated PMR regardless of treatment. Study selection and data extraction was performed independently by two investigators and disagreement was resolved through discussion. Data extracted encompassed definitions of disease activity, remission and relapse, and details regarding the instruments used to measure these outcomes.
RESULTS: From the 5,718 records, we included 26 articles on disease activity, 36 on remission, and 53 on relapse; 64 studies were observational and 15interventional, and none used qualitative methods. Some heterogeneity was found regarding definitions and instruments encompassing the domains pain, stiffness, fatigue, laboratory markers (mainly acute phase reactants), and patient and physician global assessment of disease activity. However, instruments for clinical signs were often poorly described. Whilst measurement properties of the polymyalgia rheumatica activity score (PMR-AS) have been assessed, data to support its use for measurement of remission and relapse is limited.
CONCLUSIONS: Remission, relapse, and disease activity have been defined heterogeneously in clinical studies. Instruments to measure these disease states still need to be validated. Qualitative research is needed to better understand the concepts of remission and relapse in PMR.
BACKGROUND: PROSPERO identification: CRD42021255925.
METHODS: A search of Pubmed/MEDLINE, EMBASE, CINAHL, Cochrane, and Epistemonikos was performed May 2021 and updated August 2023. Qualitative and quantitative studies published in English were included if they recruited people with isolated PMR regardless of treatment. Study selection and data extraction was performed independently by two investigators and disagreement was resolved through discussion. Data extracted encompassed definitions of disease activity, remission and relapse, and details regarding the instruments used to measure these outcomes.
RESULTS: From the 5,718 records, we included 26 articles on disease activity, 36 on remission, and 53 on relapse; 64 studies were observational and 15interventional, and none used qualitative methods. Some heterogeneity was found regarding definitions and instruments encompassing the domains pain, stiffness, fatigue, laboratory markers (mainly acute phase reactants), and patient and physician global assessment of disease activity. However, instruments for clinical signs were often poorly described. Whilst measurement properties of the polymyalgia rheumatica activity score (PMR-AS) have been assessed, data to support its use for measurement of remission and relapse is limited.
CONCLUSIONS: Remission, relapse, and disease activity have been defined heterogeneously in clinical studies. Instruments to measure these disease states still need to be validated. Qualitative research is needed to better understand the concepts of remission and relapse in PMR.
BACKGROUND: PROSPERO identification: CRD42021255925.
摘要：
目的：对用于测量缓解的定义和工具进行系统的文献综述，复发,风湿性多肌痛（PMR）的疾病活动，通知OMERACT项目认可这些成果的工具。
方法：搜索Pubmed/MEDLINE，EMBASE,CINAHL,科克伦,Epistemonikos于2021年5月进行，并于2023年8月更新。如果招募与治疗无关的孤立PMR患者，则包括以英语发表的定性和定量研究。研究选择和数据提取由两名研究者独立进行，通过讨论解决了分歧。提取的数据包括疾病活动的定义，缓解和复发，以及用于衡量这些结果的工具的详细信息。
结果：从5,718条记录中，我们收录了26篇关于疾病活动的文章，36缓解期，53例复发；64例观察性研究和15例介入性研究，没有人使用定性方法。关于包含领域疼痛的定义和工具，发现了一些异质性，刚度,疲劳,实验室标志物（主要是急性期反应物），以及患者和医生对疾病活动的全球评估。然而,临床体征的仪器通常描述不佳。虽然已经评估了风湿性多肌痛活动评分（PMR-AS）的测量特性，支持其用于缓解和复发测量的数据有限.
结论：缓解，复发,在临床研究中，疾病活动已被异质性定义。测量这些疾病状态的仪器仍需要验证。需要进行定性研究以更好地理解PMR中缓解和复发的概念。
背景：PROSPERO标识：CRD42021255925。
方法：搜索Pubmed/MEDLINE，EMBASE,CINAHL,科克伦,Epistemonikos于2021年5月进行，并于2023年8月更新。如果招募与治疗无关的孤立PMR患者，则包括以英语发表的定性和定量研究。研究选择和数据提取由两名研究者独立进行，通过讨论解决了分歧。提取的数据包括疾病活动的定义，缓解和复发，以及用于衡量这些结果的工具的详细信息。
结果：从5,718条记录中，我们收录了26篇关于疾病活动的文章，36缓解期，53例复发；64例观察性研究和15例介入性研究，没有人使用定性方法。关于包含领域疼痛的定义和工具，发现了一些异质性，刚度,疲劳,实验室标志物（主要是急性期反应物），以及患者和医生对疾病活动的全球评估。然而,临床体征的仪器通常描述不佳。虽然已经评估了风湿性多肌痛活动评分（PMR-AS）的测量特性，支持其用于缓解和复发测量的数据有限.
结论：缓解，复发,在临床研究中，疾病活动已被异质性定义。测量这些疾病状态的仪器仍需要验证。需要进行定性研究以更好地理解PMR中缓解和复发的概念。
背景：PROSPERO标识：CRD42021255925。
