QuestionnairePage 1
QUESTIONNAIRE FOR CONSENSUS AGREEMENT ON DEFINITION OF
complete REMISSION on and off medication in polymyagia rheumatica
Do you consider the following parameters important to define
complete remission on-off medication?
Your name:
A.History
1□ / 2□ / 3□Essential / Less important / Not important
Importance-Remission on medication / Importance-Remission off medication
Limits-Comments
/don’t know
/Limits-Comments
/don’t know
Morning stiffness / 1 / 2 / 3 / min / 1 / 2 / 3 / minPatient’s assessment of pain: neck, upper arms, shoulders, pelvic girdle [Visual analogue scale (VAS)] / 1 / 2 / 3 / mm / 1 / 2 / 3 / mm
Patient’s global assessment (VAS) / 1 / 2 / 3 / mm / 1 / 2 / 3 / mm
Physician’s pain assessment (VAS) / 1 / 2 / 3 / mm / 1 / 2 / 3 / mm
Physician’s global assessment (VAS) / 1 / 2 / 3 / mm / 1 / 2 / 3 / mm
HAQ-Score / 1 / 2 / 3 / points / 1 / 2 / 3 / points
Transient visual symptoms / 1 / 2 / 3 / 1 / 2 / 3
General symptoms:
Fever
weight loss
malaise
anorexia
night sweats
adynamia / 1
1
1
1
1
1 / 2
2
2
2
2
2 / 3
3
3
3
3
3 / oC
kg / 1
1
1
1
1
1 / 2
2
2
2
2
2 / 3
3
3
3
3
3 / oC
kg
Symptoms of depressed mood
apparent sadness
inner tension
pessimistic thoughts
concentration difficulties
reduced sleep / 1
1
1
1
1 / 2
2
2
2
2 / 3
3
3
3
3 / 1
1
1
1
1 / 2
2
2
2
2 / 3
3
3
3
3
Others/ general comments:
B.Physical examination
1□ / 2□ / 3□Essential / Less important / Not important
Importance-Remission on medication / Importance-Remission off medication
Limits-Comments
/don’t know
/Limits-Comments
/don’t know
Abnormality of neck clinical findings:Para cervical tenderness
limitation of motion of the cervical spine / 1
1 / 2
2 / 3
3 / 1
1 / 2
2 / 3
3
Abnormality of shoulder clinical findings:
Tenderness on palpation of upper arm muscles
Tenderness on palpation of bicipital tendon root, coracoid, tuberosities and/ or posterior cuff
Pain worsened by passive and active mobilization
Limitation of the elevation of the upper limb / 1
1
1
1 / 2
2
2
2 / 3
3
3
3 / 1
1
1
1 / 2
2
2
2 / 3
3
3
3
Abnormality of hip clinical findings:
Pain in the groin worsened by passive and active movements
(suggesting coxo- femoral synovitis)
Pain on the lateral aspect of the hip and thigh, increased by external rotation and abduction with localized tenderness on palpation over the greater trochanter with or without swelling
(suggesting trochanteric bursitis)
Tenderness aggravated by extension and relieved by flexion of the hip associated or not with palpable swelling in the area of the middle third of inguinal ligament and lateral to the femoral pulse
(suggesting ileopsoas bursitis)
Tenderness on palpation over the ischial tuberosity with or without swelling (suggesting ischiogluteal bursitis)
Tenderness on palpation of femoral muscles / 1
1
1
1
1 / 2
2
2
2
2 / 3
3
3
3
3 / 1
1
1
1
1 / 2
2
2
2
2 / 3
3
3
3
3
Peripheral manifestations:
Distal swelling with pitting oedema (RS3PE)
Peripheral arthritis
Carpal tunnel syndrome / 1
1
1 / 2
2
2 / 3
3
3 / 1
1
1 / 2
2
2 / 3
3
3
Others/ general comments:
C.LABORatory
1□ / 2□ / 3□Essential / Less important / not important
Importance-Remission on medication / Importance-Remission off medication
Limits-Comments
/don’t know
/Limits-Comments
/don’t know
Acute phase proteins
Erythrocyte sedimentation rate (ESR) / 1 / 2 / 3 / mm/1sth / 1 / 2 / 3 / mm/1sthC- reactive protein (CRP) / 1 / 2 / 3 / mg/dl / 1 / 2 / 3 / mg/dl
Alpha 2 globulin (2- globulin) / 1 / 2 / 3 / % / 1 / 2 / 3 / %
Serum amyloid A (SAA) / 1 / 2 / 3 / mg/l / 1 / 2 / 3 / mg/l
Haptoglobin (HP) / 1 / 2 / 3 / mg/dl / 1 / 2 / 3 / mg/dl
1-acid glycoprotein / 1 / 2 / 3 / mg/dl / 1 / 2 / 3 / mg/dl
Ristocetin / 1 / 2 / 3 / 1 / 2 / 3
orsomucoid / 1 / 2 / 3 / 1 / 2 / 3
Blood count
Haemoglobin / 1 / 2 / 3 / g/dl / 1 / 2 / 3 / g/dlSerum- iron ( serum- Fe2+ ) / 1 / 2 / 3 / g/dl / 1 / 2 / 3 / g/dl
Total leucocytes / 1 / 2 / 3 / G/l / 1 / 2 / 3 / G/l
Lymphocytes subset % of all Lymphocytes:
CD4
CD8
HLA-DR CD8 / 1
1
1 / 2
2
2 / 3
3
3 / %
%
% / 1
1
1 / 2
2
2 / 3
3
3 / %
%
%
Lymphocytes (N):
Total
CD4
CD8
CD4/ CD8 ratio / 1
1
1
1 / 2
2
2
2 / 3
3
3
3 / x103/l
x103/l
x103/l / 1
1
1
1 / 2
2
2
2 / 3
3
3
3 / x103/l
x103/l
x103/l
Soluble CD4 / 1 / 2 / 3 / 1 / 2 / 3
Soluble CD8 / 1 / 2 / 3 / 1 / 2 / 3
Platelets / 1 / 2 / 3 / x103/l / 1 / 2 / 3 / x103/l
Vascular damage
Fibrinogen / 1 / 2 / 3 / mg/dl / 1 / 2 / 3 / mg/dl
Plasminogen activator inhibitor- 1 (PAI-1) / 1 / 2 / 3 / AU/ml / 1 / 2 / 3 / AU/ml
Factor VIII / 1 / 2 / 3 / % / 1 / 2 / 3 / %
Vascular endothelial growth factor (VEGF) / 1 / 2 / 3 / pg/mg / 1 / 2 / 3 / pg/mg
Plasma viscosity / 1 / 2 / 3 / 1 / 2 / 3
Fibrin(ogen) related D-antigen / 1 / 2 / 3 / g/dl / 1 / 2 / 3 / g/dl
Fibronectin / 1 / 2 / 3 / mg/l / 1 / 2 / 3 / mg/l
Von Wildebrand factor (vWF) / 1 / 2 / 3 / % / 1 / 2 / 3 / %
Cytokines / Rceptors
Tumour necrosis factor (TNF-) / 1 / 2 / 3 / pg/ml / 1 / 2 / 3 / pg/mlInterleukin (IL)- 6 / 1 / 2 / 3 / pg/ml / 1 / 2 / 3 / pg/ml
Soluble IL- 6 receptor / 1 / 2 / 3 / pg/ml / 1 / 2 / 3 / pg/ml
IL- 1 / 1 / 2 / 3 / pg/ml / 1 / 2 / 3 / pg/ml
Soluble IL- 1 receptor antagonist / 1 / 2 / 3 / pg/ml / 1 / 2 / 3 / pg/ml
IL- 1 receptor antagonist/ IL- 1 ratio / 1 / 2 / 3 / pg/ml / 1 / 2 / 3 / pg/ml
IL- 10 / 1 / 2 / 3 / pg/ml / 1 / 2 / 3 / pg/ml
IL- 2 / 1 / 2 / 3 / IU/ml / 1 / 2 / 3 / IU/ml
Soluble IL- 2 receptor / 1 / 2 / 3 / ng/ml / 1 / 2 / 3 / ng/ml
Soluble IL- 2 receptor antagonist / 1 / 2 / 3 / 1 / 2 / 3
Soluble intercellular adhesion molecule 1 (sICAM-1) / 1 / 2 / 3 / ng/ml / 1 / 2 / 3 / ng/ml
Soluble vascular cell adhesion molecule (sVCAM-1) / 1 / 2 / 3 / ng/ml / 1 / 2 / 3 / ng/ml
Monocyte chemoattractant protein-1 (MCP-1) / 1 / 2 / 3 / 1 / 2 / 3
Soluble E- selectin / 1 / 2 / 3 / ng/ml / 1 / 2 / 3 / ng/ml
Complement 3/ complement 4 ratio / 1 / 2 / 3 / mg/dl / 1 / 2 / 3 / mg/dl
Immunglobulins (Ig) / 1 / 2 / 3 / mg/dl / 1 / 2 / 3 / mg/dl
Antibodies to intermediate filament / 1 / 2 / 3 / 1 / 2 / 3
Hormones
Prolaktin (PRL) / 1 / 2 / 3 / ng/ml / 1 / 2 / 3 / ng/ml
Cortisol level / 1 / 2 / 3 / g/dl / 1 / 2 / 3 / g/dl
Dehydroepiandrosterone / 1 / 2 / 3 / g/dl / 1 / 2 / 3 / g/dl
Androstendione / 1 / 2 / 3 / 1 / 2 / 3
Others
Prealbumine / 1 / 2 / 3 / ng/ml / 1 / 2 / 3 / ng/mlAkaline phosphatase / 1 / 2 / 3 / U/l / 1 / 2 / 3 / U/l
1- Antichymotrypsin / 1 / 2 / 3 / mg/dl / 1 / 2 / 3 / mg/dl
Lipoprotein (a) / 1 / 2 / 3 / mg/dl / 1 / 2 / 3 / mg/dl
Others/ general comments:
D.IMAGING
1□ / 2□ / 3□Essential / Less important / not important
1.Magnetic resonance imaging (MRI)
Importance-Remission on medication / Importance-Remission off medicationLimits-Comments
/don’t know
/Limits-Comments
/don’t know
Shoulder/neck MRI to detect:Subacromial/Subdeltoid bursitis, glenohumeral joint synovitis and/or biceps tendosynovitis / 1 / 2 / 3 / 1 / 2 / 3
Pelvic MRI to detect:
trochanteric/ileopsoatic/ischiogluteal bursitis, Coxofemoral joint synovitis and/or hip enthesitis / 1 / 2 / 3 / 1 / 2 / 3
MRI of peripheral limbs to detect:
elbow/wrist/knee/ankle joint synovitis, wrist extensor/posterior tibial/foot extensor/peroneal tendosynovitis, Carpal tunnel syndrome, RS3PE syndrome and/or plantar fasciitis / 1 / 2 / 3 / 1 / 2 / 3
Others/ general comments
2.Ultrasound (US)
Importance-Remission on medication / Importance-Remission off medicationLimits-Comments
/don’t know
/Limits-Comments
/don’t know
Shoulder/neck US to detect:Subacromial/Subdeltoid bursitis, glenohumeral joint synovitis and/or biceps tendosynovitis / 1 / 2 / 3 / 1 / 2 / 3
Pelvic US to detect:
trochanteric/ileopsoatic/ischiogluteal bursitis, Coxofemoral joint synovitis and/or hip enthesitis / 1 / 2 / 3 / 1 / 2 / 3
US of peripheral limbs to detect:
elbow/wrist/knee/ankle joint synovitis, wrist extensor/posterior tibial/foot extensor/peroneal tendosynovitis, Carpal tunnel syndrome, RS3PE syndrome and/or plantar fasciitis / 1 / 2 / 3 / 1 / 2 / 3
Others/ general comments
3.18F-Fluorodeoxyglucose Positron emission tomography (18F-FDG-PET)
Importance-Remission on medication / Importance-Remission off medicationLimits-Comments
/don’t know
/Limits-Comments
/don’t know
18 FDG-uptake in muscles (bilateral) / 1 / 2 / 3 / 1 / 2 / 3Others/ general comments
F. Therapy
1□ / 2□ / 3□Essential / Less important / not important
Importance-Remission on medication / Importance-Remission off medication
Limits-Comments
/don’t know
/Limits-Comments
/don’t know
Assessment of corticosteroid dose required to control symptoms / 1 / 2 / 3 / mg/day / 1 / 2 / 3 / mg/dayOthers/ general comments: