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 5718 records, we included 26 articles on disease activity, 36 on remission and 53 on relapse; 64 studies were observational and 15 interventional, 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 are limited. Conclusion 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. Review registration PROSPERO identification: CRD42021255925.

中文翻译：

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风湿性多肌痛疾病活动度、缓解和复发的定义和工具：系统文献综述


目的 对用于测量风湿性多肌痛 （PMR） 缓解、复发和疾病活动的定义和工具进行系统的文献综述，为 OMERACT 项目提供信息，以认可这些结果的工具。方法 2021 年 5 月对 Pubmed/MEDLINE、EMBASE、CINAHL、Cochrane 和 Epistemonikos 进行了检索，并于 2023 年 8 月进行了更新。如果以英文发表的定性和定量研究招募孤立性 PMR 患者，则无论治疗如何，均被纳入。研究选择和数据提取由两名研究者独立进行，分歧通过讨论解决。提取的数据包括疾病活动、缓解和复发的定义，以及用于测量这些结果的工具的详细信息。结果 从 5718 条记录中，我们纳入了 26 篇关于疾病活动的文章，36 篇关于缓解的文章，53 篇关于复发的文章;64 项研究是观察性研究，15 项是干预性研究，没有一项研究使用定性方法。在包括疼痛、僵硬、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整体评估在内的定义和工具方面发现了一些异质性。然而，临床体征的仪器往往描述不佳。虽然已经评估了风湿性多肌痛活动评分 （PMR-AS） 的测量特性，但支持其用于测量缓解和复发的数据有限。结论 缓解、复发和疾病活动度在临床研究中定义存在异质性。测量这些疾病状态的仪器仍然需要验证。需要定性研究来更好地了解 PMR 缓解和复发的概念。 评论注册 PROSPERO 鉴定：CRD42021255925。