The Prevalence of Shoulder and Hip Joints Ultrasound Findings in Polymyalgia Rheumatica: A Multicenter International Study

Alojzija Hocevar¹, PIERLUIGI MACCHIONI², Irene Monjo³, Rositsa Karalilova⁴, Edoardo Conticini⁵, Alessandro Tomelleri⁶, Cristina Ponte⁷, Sara Monti⁸, Giulia Klinowski⁹, Zguro Batalov⁴, Paolo Falsetti¹⁰, Corrado Campochiaro¹¹ and Eugenio De Miguel³, ¹Department of Rheumatology, Universitiy Medical Centre Ljubljana, Ljubljana, Slovenia, ²Azienda USL -IRCCS di Reggio Emilia, Reggio Emilia, Italy, ³Hospital Universitario La Paz, Madrid, Spain, ⁴Medical University of Plovdiv, University Hospital Kaspela, Plovdiv, Bulgaria, ⁵Tallaght University Hospital, Dublin, Ireland, ⁶Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milano, Italy, ⁷Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal, ⁸Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy, ⁹IRCCS-S.Maria Nuova, Reggio Emilia, Italy, ¹⁰San Raffaele Scientific Institute, Siena, Italy, ¹¹IRCCS San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Disease. Vita-Salute San Raffaele University, Milan, Italy

Meeting: ACR Convergence 2023

Keywords: Diagnostic criteria, Polymyalgia Rheumatica (PMR), Ultrasound

Session Information

Date: Monday, November 13, 2023

Title: (1033–1051) Imaging of Rheumatic Diseases Poster I

Session Type: Poster Session B

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

Background/Purpose: Musculoskeletal ultrasound (US) is a validated method for the objective assessment of the pathological changes occurring in PMR. It assists the diagnosis of the disease and increases the performance of 2012 ACR/EULAR classification criteria for PMR⁽¹⁾. The aim of our international multicenter study was to determine the prevalence of US findings characteristic for PMR in a cohort of newly diagnosed PMR patients.

Methods: Our PMR cohort included 390 consecutive clinically diagnosed patients from eight rheumatology centers.At diagnosis, patients underwent a bilateral US examination of shoulder and hip joints. Only patients who had no missing data were included in the analysis. The presence of joint effusion (hip, glenohumeral), bursitis (subdeltoid, trochanteric) and tenosynovitis (long biceps tendon) was recorded.

Results: A complete US examination was performed in 289 PMR patients. Mean (SD) age was 73.1 (9.7) years and 159 patients were female (55.0%). All PMR patients had at least one pathologic US finding. The presence of biceps tendosynovitis (mostly bilateral) was the most frequently recorded abnormality, disclosed in 240 patients (83.0%). The prevalence of individual pathologic US findings is reported in Table 1. The two US items included in the PMR classification criteria “at least 1 shoulder with subdeltoid bursitis and/or biceps tendosynovitis and/or glenohumeral synovitis and at least 1 hip with synovitis and/or trochanteric bursitis” (item 1) and “bilateral shoulder with subdeltoid bursitis, biceps tendosynovitis, or glenohumeral synovitis” (item 2) were fulfilled in 153 cases (52.9 %) and 269 cases (93.1%), respectively. Patients who fulfilled item 1 of US classification criteria had a higher CRP level compared to those who did not ((mean (SD) CRP 59.4 (48.1)vs 42.0 (40.7) mg/l (p < 0.001) for patients that not fulfilled this item, since No other associations regarding US criteria, sex, age, ESR and CRP were found.

Conclusion: At least one US abnormality of shoulder or hip joints was found in all our PMR patients, with bilateral tendosynovitis of long biceps tendon being the most common finding 83%. Ultrasound PMR classification criteria were met in 52.9% patients for item 1 and in 93.1% patients for item 2.

References:

1 Dasgupta B et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2012; 71: 484–92.

Acknowledgements: To the GCA/PMR study group

Disclosures: A. Hocevar: None; P. MACCHIONI: None; I. Monjo: None; R. Karalilova: None; E. Conticini: None; A. Tomelleri: Novartis, 1; C. Ponte: None; S. Monti: CSL Vifor, 6; G. Klinowski: None; Z. Batalov: None; P. Falsetti: None; C. Campochiaro: Boehringer Ingelheim, 1, 6, Janssen, 1, 6, Novartis, 1, 6; E. De Miguel: None.

To cite this abstract in AMA style:

Hocevar A, MACCHIONI P, Monjo I, Karalilova R, Conticini E, Tomelleri A, Ponte C, Monti S, Klinowski G, Batalov Z, Falsetti P, Campochiaro C, De Miguel E. The Prevalence of Shoulder and Hip Joints Ultrasound Findings in Polymyalgia Rheumatica: A Multicenter International Study [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/the-prevalence-of-shoulder-and-hip-joints-ultrasound-findings-in-polymyalgia-rheumatica-a-multicenter-international-study/. Accessed .

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