Background/Purpose:

The new EULAR/ACR 2012 classification criteria for polymyalgia rheumatica (PMR) are the first classification criteria that contain musculoskeletal ultrasound (MUS) in an additional algorithm resulting in an increased specificity. Therefore, the joint involvement has been investigated by MUS in a cohort of recent onset PMR patients analyzing the distribution of the novel ultrasound criteria. 

Methods:

All patients of our tertiary rheumatology center with newly diagnosed PMR between 01/2011 and 06/2012 were included in this retrospective study. MUS has been performed in all patients with suspected PMR. The final diagnosis of PMR was established by a rheumatologist according to physical examination, laboratory analysis, MUS, and after excluding other conditions mimicking PMR. 

Results:

In 35 patients the diagnosis of PMR was established. Pathological MUS findings of shoulder or hip joints were present in 80.0 % of these patients. Biceps tenosynovitis, subdeltoid bursitis or glenohumeral synovitis of at least one shoulder were observed in 74.3% patients. Of those patients with pathological MUS findings of the shoulder, 92.3 % had a biceps tenosynovitis of at least one shoulder, 80.8 % presented with bilateral biceps tenosynovitis, whereas only 46.2 % had a subdeltoid bursitis and 34.6 % a glenohumeral synovitis of at least one shoulder. Synovitis or trochanteric bursitis of at least 1 hip could be detected in 25.7 % of all PMR patients. 66.7 % of the patients with hip affection in MUS presented with pathological MUS findings of both hips and both shoulders (Tab. 1).

 Conclusion:

The most common pathological ultrasound finding in patients with PMR was a (bilateral) biceps tenosynovitis. Pathological ultrasound findings of the hips were less frequent, but in two thirds of these patients combined with pathological findings of both hips and both shoulders.

Table 1:MUS findings in PMR patients.

	PMR-Patients (n = 35)
At least 1 shoulder with biceps tenosynovitis, subdeltoid bursitis or glenohumeral synovitis	26 (74.3 %)
Both shoulders with biceps tenosynovitis, subdeltoid bursitis or glenohumeral synovitis	24 (68.6 %)
At least 1 shoulder with biceps tenosynovitis or subdeltoid bursitis	26 (74.3 %)
Both shoulders with biceps tenosynovitis or subdeltoid bursitis	22 (62.9 %)
At least 1 shoulder with biceps tenosynovitis	24 (68.6 %)
Both shoulders with biceps tenosynovitis	21 (60.0 %)
At least 1 hip with synovitis or trochanteric bursitis	9 (25.7 %)
Both hips with synovitis or trochanteric bursitis	7 (20.0 %)
Patients with no pathological finding as above	7 (20.0 %)
At least 1 shoulder and 1 hip with findings as above	7 (20.0 %)
Both shoulders and both hips with findings as above	6 (17.1 %)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-joint-involvement-in-patients-suffering-from-early-polymyalgia-rheumatica-using-high-resolution-ultrasound/