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Longitudinal examination with shoulder ultrasound of patients with polymyalgia rheumatica
Rheumatology, 10/12/09

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.

• 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

• 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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