# ACR/EULAR PMR classification criteria

ACR/EULAR PMR

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/acr_eular_pmr`
HTML: https://magentlab.com/docs/acr-eular-pmr
Markdown: https://magentlab.com/docs/acr-eular-pmr.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply the 2012 EULAR/ACR polymyalgia rheumatica classification criteria (Dasgupta Table 4): require age ≥50, bilateral shoulder aching, and abnormal CRP and/or ESR, then return the clinical score with or without optional ultrasound and whether the published cut point classifies PMR. Not a PMR diagnosis.

## When to use

When an agent already has caller-assigned Dasgupta 2012 required criteria and scoring items and needs the published PMR classification result for research, not a PMR diagnosis.

## When not to use

- Not a medical device and not a PMR diagnosis. These criteria are not meant for diagnostic purposes (Dasgupta 2012).
- Required criteria (age 50–120, bilateral shoulder aching, and abnormal CRP and/or ESR) must be met or the request is HTTP 400 and is not scored.
- magent does not assay CRP, ESR, RF, or ACPA and does not perform ultrasound. Ultrasound items apply only when include_ultrasound is true.
- Classification criteria for research, not a treatment or glucocorticoid-start decision.

## Formula

```
ACR/EULAR 2012 PMR classification (Dasgupta Table 4): required age 50–120, bilateral_shoulder_aching true, abnormal_crp_or_esr true (else do not score). Score = morning_stiffness_gt_45 2 + hip_pain_or_limited_rom 1 + rf_or_acpa_absent 2 + other_joint_pain_absent 1. Without ultrasound: max 6, classified iff score ≥4. With ultrasound: add us_shoulder_and_hip 1 + us_both_shoulders 1; max 8, classified iff score ≥5. Not a diagnosis (not meant for diagnostic purposes)
```

## Citation

[2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative](https://doi.org/10.1136/annrheumdis-2011-200329)
Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Amo MD, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Mazlumzadeh M, Salvarani C
Ann Rheum Dis. 2012;71(4):484-492
DOI: [10.1136/annrheumdis-2011-200329](https://doi.org/10.1136/annrheumdis-2011-200329)

## Worked example

### All clinical items, no ultrasound, classified

Given: `abnormal_crp_or_esr=true, age=70, bilateral_shoulder_aching=true, hip_pain_or_limited_rom=true, include_ultrasound=false, morning_stiffness_gt_45=true, other_joint_pain_absent=true, rf_or_acpa_absent=true`

1. Required: age 70, bilateral_shoulder_aching true, abnormal_crp_or_esr true
2. morning_stiffness_gt_45 2 + hip_pain_or_limited_rom 1 + rf_or_acpa_absent 2 + other_joint_pain_absent 1
3. include_ultrasound false; score = 6 (max 6) ≥4; classified true; algorithm without_ultrasound


### Required entry only, no ultrasound, not classified

Given: `abnormal_crp_or_esr=true, age=70, bilateral_shoulder_aching=true, hip_pain_or_limited_rom=false, include_ultrasound=false, morning_stiffness_gt_45=false, other_joint_pain_absent=false, rf_or_acpa_absent=false`

1. Scoring flags false; include_ultrasound false
2. Score = 0 (max 6) <4; classified false; algorithm without_ultrasound


### Clinical 6 plus shoulder-and-hip ultrasound, classified

Given: `abnormal_crp_or_esr=true, age=70, bilateral_shoulder_aching=true, hip_pain_or_limited_rom=true, include_ultrasound=true, morning_stiffness_gt_45=true, other_joint_pain_absent=true, rf_or_acpa_absent=true, us_both_shoulders=false, us_shoulder_and_hip=true`

1. Clinical items 6; include_ultrasound true; us_shoulder_and_hip 1; us_both_shoulders 0
2. Score = 7 (max 8) ≥5; classified true; algorithm with_ultrasound


### Clinical 4 with ultrasound, not classified

Given: `abnormal_crp_or_esr=true, age=70, bilateral_shoulder_aching=true, hip_pain_or_limited_rom=false, include_ultrasound=true, morning_stiffness_gt_45=true, other_joint_pain_absent=false, rf_or_acpa_absent=true, us_both_shoulders=false, us_shoulder_and_hip=false`

1. morning_stiffness_gt_45 2 + rf_or_acpa_absent 2; both US flags false
2. Score = 4 (max 8) <5; classified false; algorithm with_ultrasound


## Also searched as

- ACR EULAR PMR
- 2012 PMR classification criteria
- Dasgupta 2012 PMR
- polymyalgia rheumatica classification
- EULAR ACR PMR score
- PMR ultrasound classification
- ACR/EULAR 2012 PMR
- provisional PMR classification

## Parameters

- `age` (integer, required): Age in years as an integer 50–120 (Dasgupta 2012 required criterion: age ≥50). magent does not date the patient.
- `bilateral_shoulder_aching` (boolean, required): Must be true. Dasgupta 2012 required criterion: bilateral shoulder aching. false is invalid and is not scored. magent does not examine joints.
- `abnormal_crp_or_esr` (boolean, required): Must be true. Dasgupta 2012 required criterion: abnormal CRP and/or ESR. false is invalid and is not scored. magent does not assay CRP or ESR.
- `morning_stiffness_gt_45` (boolean, required): Morning stiffness duration >45 min (Dasgupta 2012 Table 4). true scores 2; false scores 0. magent does not take a history.
- `hip_pain_or_limited_rom` (boolean, required): Hip pain or limited range of motion (Dasgupta 2012 Table 4). true scores 1; false scores 0. magent does not examine joints.
- `rf_or_acpa_absent` (boolean, required): Absence of RF or ACPA as assigned by the caller (Dasgupta 2012 Table 4). true scores 2; false scores 0. magent does not assay RF or ACPA.
- `other_joint_pain_absent` (boolean, required): Absence of other/peripheral joint involvement as assigned by the caller (Dasgupta 2012 Table 4). true scores 1; false scores 0. magent does not examine joints.
- `include_ultrasound` (boolean, required): Use the optional ultrasound algorithm (Dasgupta 2012 Table 4). false: do not require US flags; max 6; classified iff score ≥4. true: require us_shoulder_and_hip and us_both_shoulders; max 8; classified iff score ≥5. magent does not perform ultrasound.
- `us_shoulder_and_hip` (boolean, optional): At least one shoulder with subdeltoid bursitis and/or biceps tenosynovitis and/or glenohumeral synovitis (posterior or axillary) and at least one hip with synovitis and/or trochanteric bursitis (Dasgupta 2012). true scores 1. Required when include_ultrasound is true; ignored when false. magent does not perform ultrasound.
- `us_both_shoulders` (boolean, optional): Both shoulders with subdeltoid bursitis, biceps tenosynovitis, or glenohumeral synovitis (Dasgupta 2012). true scores 1. Required when include_ultrasound is true; ignored when false. magent does not perform ultrasound.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/acr_eular_pmr`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "abnormal_crp_or_esr": "true",
      "age": "70",
      "bilateral_shoulder_aching": "true",
      "hip_pain_or_limited_rom": "true",
      "include_ultrasound": "false",
      "morning_stiffness_gt_45": "true",
      "other_joint_pain_absent": "true",
      "rf_or_acpa_absent": "true"
    },
    {
      "abnormal_crp_or_esr": "true",
      "age": "70",
      "bilateral_shoulder_aching": "true",
      "hip_pain_or_limited_rom": "true",
      "include_ultrasound": "false",
      "morning_stiffness_gt_45": "true",
      "other_joint_pain_absent": "true",
      "rf_or_acpa_absent": "true"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/acr-eular-pmr

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/acr_eular_pmr",
  "items": [
    {
      "components": [
        {
          "factor": "morning_stiffness_gt_45",
          "points": 2,
          "present": true
        },
        {
          "factor": "hip_pain_or_limited_rom",
          "points": 1,
          "present": true
        },
        {
          "factor": "rf_or_acpa_absent",
          "points": 2,
          "present": true
        },
        {
          "factor": "other_joint_pain_absent",
          "points": 1,
          "present": true
        }
      ],
      "algorithm": "without_ultrasound",
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Amo MD, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Mazlumzadeh M, Salvarani C",
        "doi": "10.1136/annrheumdis-2011-200329",
        "id": "dasgupta-2012",
        "pmid": "22388996",
        "source": "Ann Rheum Dis. 2012;71(4):484-492",
        "title": "2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative"
      },
      "formula": "acr_eular_pmr",
      "formula_expression": "ACR/EULAR 2012 PMR classification (Dasgupta Table 4): required age 50–120, bilateral_shoulder_aching true, abnormal_crp_or_esr true (else do not score). Score = morning_stiffness_gt_45 2 + hip_pain_or_limited_rom 1 + rf_or_acpa_absent 2 + other_joint_pain_absent 1. Without ultrasound: max 6, classified iff score ≥4. With ultrasound: add us_shoulder_and_hip 1 + us_both_shoulders 1; max 8, classified iff score ≥5. Not a diagnosis (not meant for diagnostic purposes)",
      "max_score": 6,
      "score": 6,
      "classified": true
    },
    {
      "components": [
        {
          "factor": "morning_stiffness_gt_45",
          "points": 2,
          "present": true
        },
        {
          "factor": "hip_pain_or_limited_rom",
          "points": 1,
          "present": true
        },
        {
          "factor": "rf_or_acpa_absent",
          "points": 2,
          "present": true
        },
        {
          "factor": "other_joint_pain_absent",
          "points": 1,
          "present": true
        }
      ],
      "algorithm": "without_ultrasound",
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Amo MD, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Mazlumzadeh M, Salvarani C",
        "doi": "10.1136/annrheumdis-2011-200329",
        "id": "dasgupta-2012",
        "pmid": "22388996",
        "source": "Ann Rheum Dis. 2012;71(4):484-492",
        "title": "2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative"
      },
      "formula": "acr_eular_pmr",
      "formula_expression": "ACR/EULAR 2012 PMR classification (Dasgupta Table 4): required age 50–120, bilateral_shoulder_aching true, abnormal_crp_or_esr true (else do not score). Score = morning_stiffness_gt_45 2 + hip_pain_or_limited_rom 1 + rf_or_acpa_absent 2 + other_joint_pain_absent 1. Without ultrasound: max 6, classified iff score ≥4. With ultrasound: add us_shoulder_and_hip 1 + us_both_shoulders 1; max 8, classified iff score ≥5. Not a diagnosis (not meant for diagnostic purposes)",
      "max_score": 6,
      "score": 6,
      "classified": true
    }
  ]
}
```

## Response fields

- `formula` (string): acr_eular_pmr
- `formula_expression` (string): Dasgupta 2012 EULAR/ACR PMR classification expression
- `score` (integer): Dasgupta 2012 Table 4 points. 0–6 without ultrasound; 0–8 with ultrasound.
- `max_score` (integer): 6 without ultrasound; 8 with ultrasound
- `classified` (boolean): true iff score ≥4 without ultrasound or score ≥5 with ultrasound. Classification criteria for research, not a PMR diagnosis.
- `algorithm` (string): without_ultrasound when include_ultrasound is false; with_ultrasound when true
- `components` (array): Per-item Dasgupta 2012 points
- `citation` (object): Dasgupta 2012 Ann Rheum Dis citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "factor": "morning_stiffness_gt_45",
      "points": 2,
      "present": true
    },
    {
      "factor": "hip_pain_or_limited_rom",
      "points": 1,
      "present": true
    },
    {
      "factor": "rf_or_acpa_absent",
      "points": 2,
      "present": true
    },
    {
      "factor": "other_joint_pain_absent",
      "points": 1,
      "present": true
    }
  ],
  "algorithm": "without_ultrasound",
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Amo MD, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Mazlumzadeh M, Salvarani C",
    "doi": "10.1136/annrheumdis-2011-200329",
    "id": "dasgupta-2012",
    "pmid": "22388996",
    "source": "Ann Rheum Dis. 2012;71(4):484-492",
    "title": "2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative"
  },
  "formula": "acr_eular_pmr",
  "formula_expression": "ACR/EULAR 2012 PMR classification (Dasgupta Table 4): required age 50–120, bilateral_shoulder_aching true, abnormal_crp_or_esr true (else do not score). Score = morning_stiffness_gt_45 2 + hip_pain_or_limited_rom 1 + rf_or_acpa_absent 2 + other_joint_pain_absent 1. Without ultrasound: max 6, classified iff score ≥4. With ultrasound: add us_shoulder_and_hip 1 + us_both_shoulders 1; max 8, classified iff score ≥5. Not a diagnosis (not meant for diagnostic purposes)",
  "max_score": 6,
  "score": 6,
  "classified": true
}
```

## Errors

- HTTP 400 `invalid_pmr_age`: age must be an integer from 50 to 120 (Dasgupta 2012 EULAR/ACR PMR required criterion). Returned before settlement; you are not charged.
- HTTP 400 `invalid_pmr`: bilateral_shoulder_aching and abnormal_crp_or_esr must be true; include_ultrasound must be true or false (Dasgupta 2012 required criteria). Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [ACR/EULAR gout](https://magentlab.com/docs/acr-eular-gout) — Apply the 2015 ACR/EULAR gout classification criteria (Neogi Table 2): require the entry episode, classify immediately if MSU crystals are present, otherwise return the Step 3 score (max 23) and whether score ≥8 classifies gout. Not a gout diagnosis.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.