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Abstract Number: 2773

Whole-Body MRI Reveals Characteristic Extracapsular Pattern of Inflammation in Polymyalgia Rheumatica

Sarah Mackie1, Colin T. Pease2, Eiki Fukuba3, Paul Emery4, Richard J. Hodgson4, Jane E. Freeston5 and Dennis McGonagle6, 1NIHR-Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, United Kingdom, 2Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, 3Department of Radiology, Faculty of Medicine, Shimane University, Shimane, Japan, 4NIHR-Leeds Musculoskeletal Biomedical Research Unit and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, 5NIHR-Leeds Musculoskeletal Biomedical Research Unit and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds., United Kingdom, Leeds, United Kingdom, 6Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Magnetic resonance imaging (MRI) and polymyalgia rheumatica

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Session Information

Session Title: Vasculitis

Session Type: Abstract Submissions (ACR)

Background/Purpose

Polymyalgia rheumatica (PMR) is a disease of widespread musculoskeletal inflammation characterized by pain and stiffness in shoulder and hip girdles. Here we report the first use of whole-body MRI to study the clinical spectrum of PMR in the rheumatology clinic. We hypothesized that PMR is characterized by an extracapsular pattern of inflammation.

Methods

38 participants underwent whole-body MRI: 22 consecutive cases of clinically-diagnosed, active PMR identified by two rheumatologists with a special interest in PMR and followed up for a mean of 21 months; and 16 patients (controls) selected from a larger inflammatory arthritis (RA) cohort. 4 of the PMR patients did not have gadolinium enhancement, due to contra-indications. Anonymised gadolinium-enhanced MRI scans were consensus scored in axial view using semi-quantitative grading, and the features best discriminating PMR from RA were identified. Patients were treated after the MRI with 15mg prednisolone and then asked at follow-up whether they now felt back to normal.

Results

A characteristic pattern suggesting PMR was classified as “PMR pattern” by the blinded scorers; this could be identified both on the gadolinium-enhanced and non-enhanced scans. The features best discriminating PMR from RA were inflammation in the following sites: extending up around the rim of the acetabulum (“peri-acetabular”); around the ischial tuberosity; within the hip joint; around the greater trochanter; and around the symphysis pubis (Figure). Of all the MRIs performed in patients with a clinical diagnosis of PMR, “PMR pattern” was significantly associated with patient-defined glucocorticoid responsiveness (p=0.01).

Conclusion

A characteristic, extracapsular pattern of inflammation in PMR can be identified, and defines a subgroup of the clinical spectrum of PMR with excellent patient-reported glucocorticoid responsiveness. MRI is particularly useful in assessing inflammation of structures around the pelvis.


Disclosure:

S. Mackie,
None;

C. T. Pease,
None;

E. Fukuba,
None;

P. Emery,

AbbVie, Bristol-Myers Squibb (BMS), MSD, Novartis, Pfizer Inc, Roche, and UCB Pharma,

2,

AbbVie, Bristol-Myers Squibb (BMS), MSD, Novartis, Pfizer Inc, Roche, and UCB Pharma,

5;

R. J. Hodgson,
None;

J. E. Freeston,
None;

D. McGonagle,
None.

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