The multidisciplinary and international panel used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology to evaluate the evidence. The direction (i.e., in favor of or against) and strength (i.e., strong or conditional) of the recommendations are based on the quality of the evidence, the balance between desirable and undesirable effects, values and preferences of the patients and clinicians, and resource use.1 (A more complete description of the methods used in this study can be found online.)
In all, the ACR and EULAR jointly developed nine recommendations that cover a number of treatment-related issues, including initial GC dose and tapering regimens, risk factor assessment for GC use, use of intramuscular GCs, DMARDs, the role of non-steroidal anti-inflammatory drugs (NSAIDs) and non-pharmacologic interventions (see Table 1). Issues related to patient access to medical care, specialist referral and investigations of patients under treatment are also covered.
Along with these recommendations, the panel of investigators formulated what they call eight overarching principles that reflect the current standards of clinical care of PMR—including patient and clinician values and preferences—that the panel determined were important for patients to know (see Table 2). These overarching principles, general in nature and design, highlight the importance of patient education regarding PMR and their ability to rapidly and easily access physician advice and support as needed.