Background/Purpose
ACR/EULAR provisional classification criteria for polymyalgia rheumatica (PMR) incorporate musculoskeletal ultrasound of shoulder and hip (bursitis and synovitis given equal weight). Our objective was to systematically review diagnostic accuracy of imaging features of PMR: the reference standard was rheumatologist diagnosis.
Methods
Data sources were MEDLINE, EMBASE and PubMed searches; hand-searching; and experts in the field. Two authors independently reviewed search outputs and discussed disagreements. 1764 citations yielded 23 eligible studies. Data were extracted by two authors independently. Methodological quality was assessed by 3 authors using QUADAS-2. Hierarchical summary receiver operating curve (HSROC) models were constructed where appropriate, and positive/negative likelihood ratios (LR+/LR-) calculated.
Results
23 studies with data from 2328 patients were evaluated: musculoskeletal ultrasound (9 studies), vascular ultrasound (6), magnetic resonance imaging (MRI) (6), and positron emission tomography (PET) (2). One further article (musculoskeletal ultrasound) was published during the preparation of this review. Internal and external validity varied, as did the clinical spectrum. All but one of the studies had a diagnostic case-control design. The most useful imaging features were subacromial-subdeltoid bursitis (SAB) on one or both sides (4 ultrasound studies: LR+ 2.5 (1.6 to 3.8); LR- 0.30 (0.11 to 0.81)), bilateral SAB (4 ultrasound studies: LR+ 6.2 (1.2 to 32); LR- 0.38 (0.15 to 0.97)), and presence of trochanteric bursitis (2 ultrasound, 1 MRI and 1 PET study: LR+ 5.4 (3.3 to 8.8), LR- 0.076 (0.002 to 2.8)). Hip or shoulder synovitis LRs were closer to the non-informative ratio of 1.0. Interspinous bursitis (LR+ 4.5 (1.5 to 13), LR- 0.26 (0.093 to 0.73)) and ischiogluteal bursitis (LR+ 3.6 (1.5 to 8.8), LR- 0.19 (0.05 to 0.69)) were detected by PET scans rather than ultrasound.
Conclusion
Based on current evidence, the most useful imaging features for the diagnosis of PMR appear to be SAB, bilateral SAB and trochanteric bursitis, rather than shoulder or hip synovitis.
Disclosure:
S. Mackie,
None;
G. Koduri,
None;
C. L. Hill,
None;
A. Hutchings,
None;
R. J. Wakefield,
None;
B. Dasgupta,
Novartis Pharma AG,
2;
J. Wyatt,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-use-of-imaging-in-the-diagnosis-of-polymyalgia-rheumatica-systematic-literature-review-and-meta-analysis/