ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 150

Ultrasonography and Magnetic Resonance Imaging Changes in Polymyalgia Rheumatica Patients Treated By Tocilizumab

Anais Huwart1, Florent Garrigues2, Sandrine Jousse-Joulin3, Thierry Marhadour4, Jean-Marie Berthelot5, Maelenn Gouillou6, Alain Saraux7 and Valerie Devauchelle-Pensec8, 1Radiology, Cavale Blanche Hospital and Brest Occidentale University, Brest, France, 2Radiology department, Cavale Blanche Hospital and Brest Occidentale University, Brest, France, 3Rheumatology, CHu La cavle Blanche, Brest, France, 4Rheumatology, CHU La Cavale Blanche, Brest, France, 5Service Rheumatology, CHU de Nantes, Nantes, France, 6Clinical Investigation Centre (CIC) 1412, CHU Cavale Blanche- Institut National de la Santé et de la Recherche Médicale (INSERM), Brest, France, 7Rheumatology Department, CHU de la Cavale Blanche, Brest Cedex, France, 8Rheumatology, Brest university medical school, EA 2216, Lab Ex, INSERM, IGO,UBO and CHU de la Cavale Blanche,, Brest, France

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Sunday, November 13, 2016

Title: Imaging of Rheumatic Diseases - Poster I: Ultrasound and Emerging Technologies

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Clinical and biological exams are the basis for polymyalgia rheumatic (PMR) monitoring. New imaging techniques such as ultrasound (US) and magnetic resonance imaging (MRI) were recently developed to assess diagnosis and activity of PMR (1). However, concordances between MRI and US, and their sensitivity to change, have never been evaluated. Our objectives were to assess 1- imaging changes of both MRI and US (bursitis and intra articular effusion modifications) in patients treated by tocilizumab and which technique is more able to detect improvements according to the site and 2- the concordance between US and MRI at the first visit.

Methods: 20 glucocorticoid-free patients fulfilling Chuang’s PMR criteria, with recent and active disease, were included in a prospective open-label study [ClinicalTrials.gov: NCT01713842] (2). They received three tocilizumab infusions at weeks 0, 4 and 8, without glucocorticoids, followed by oral prednisone from weeks 12 to 24. 18 patients were examined with both US (B and power Doppler mode) and MRI (T1 and T2-STIR weighted sequences) at baseline, week 2 and week 12. A semi-quantitative analysis was performed, scoring from 0 to 3 the disease activity (0= no lesion, 1= mild, 2 = moderate, 3= marked). Imaging were read by one blind reader for MRI and two trained readers for US. Wilcoxon signed-rank test and weighted Kappa coefficient were used for statistical analysis.

Results: 28 shoulders and 30 hips were analysed. No concordance between US and MRI observations was significantly noted at baseline. Activity significantly changed between week 0 and week 12 for hips and shoulders bursitis with MRI (p = 0,005) and US (p=0,029). Considering effusion, imaging lesions of all the joints significantly changed in US (p =0,001) but not in MRI (p=0,231). Bursitis improvement was detected more easily by MRI for the hips (73 %) and by US for the shoulders (57 %). Shoulders and hips effusions significantly regressed in US (improvement 25 to 47%). There was a low proportion of worsening, whether for bursitis (5% with MRI and 17,5% with US) or effusion (10 % with MRI and 3,5% with US).

Conclusion:

US and MRI allow to evaluate the evolution of joints involvement in PMR patients treated by tocilizumab. The two imaging techniques should be used differently, considering shoulders or hips for MRI.

1 Dasgupta B et al. Rheumatology 2010;49:186–90. 2-Devauchelle-Pensec V et al Ann Rheum Dis. 2016 Feb29.doi:10.1136. .

Disclosure: A. Huwart, None; F. Garrigues, None; S. Jousse-Joulin, None; T. Marhadour, None; J. M. Berthelot, None; M. Gouillou, None; A. Saraux, None; V. Devauchelle-Pensec, Roche -Chugai, 2.

To cite this abstract in AMA style:

Huwart A, Garrigues F, Jousse-Joulin S, Marhadour T, Berthelot JM, Gouillou M, Saraux A, Devauchelle-Pensec V. Ultrasonography and Magnetic Resonance Imaging Changes in Polymyalgia Rheumatica Patients Treated By Tocilizumab [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/ultrasonography-and-magnetic-resonance-imaging-changes-in-polymyalgia-rheumatica-patients-treated-by-tocilizumab/. Accessed .

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