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Longitudinal examination with shoulder ultrasound of patients with polymyalgia rheumatica
Rheumatology, 10/08/09

Macchioni PL et al. – Subclinical inflammation detected by US persists in most PMR patients despite glucocorticoid treatment. PDUS may be useful to detect at diagnosis the patients with most active inflammation who have a higher risk of relapses/recurrences.

Methods

Mean of 41 mos, 57 consecutive untreated patients with PMR prospectively assessed for relapses/recurrences
Cohort represented all patients diagnosed over 18-month period in one Italian secondary referral centre
Clinical signs and symptoms, ESR and CRP evaluated
US examination of shoulders performed in all 57 patients at diagnosis and after onset of prednisone treatment
Power Doppler ultrasonography (PDUS) performed in 24 patients
Shoulder sonograms obtained according to standardized techniques

Results

Prednisone therapy significantly reduced frequency and degree of subacromial/subdeltoid bursitis, long head biceps tenosynovitis and glenohumeral synovitis
At diagnosis, positive PD signal observed more frequently in subacromial/subdeltoid bursae (33%)
Prednisone therapy significantly reduced frequency of patients with positive PD signal
Of 44 patients in remission or with low disease activity at time of the second US, 26 (59%) still had evidence of persistent inflammatory lesions
No association between persistence of inflammation at US and relapses/recurrences; in contrast, positive PD signal at diagnosis significantly associated with occurrence of relapses/recurrences at follow-up

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