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Ann Rheum Dis. 2015 Dec;74(12):2188-92. doi: 10.1136/annrheumdis-2015-207395. Epub 2015 Sep 16.

Whole-body MRI of patients with polymyalgia rheumatica identifies a distinct subset with complete patient-reported response to glucocorticoids.

Author information

1
Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
2
Leeds Teaching Hospitals NHS Trust, Leeds, UK.
3
Department of Radiology, Shimane University, Izumo, Japan.
4
Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK.
5
Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK University of Manchester Centre for Imaging Sciences, Manchester, UK.

Abstract

OBJECTIVES:

To determine whether whole-body MRI defines clinically relevant subgroups within polymyalgia rheumatica (PMR) including glucocorticoid responsiveness.

METHODS:

22 patients with PMR and 16 with rheumatoid arthritis (RA), untreated and diagnosed by consultant rheumatologists, underwent whole-body, multiple-joint MRI, scored by two experts. Patients with PMR reported whether they felt 'back to normal' on glucocorticoid therapy and were followed for a median of 2 years.

RESULTS:

All patients with PMR were deemed to respond to glucocorticoids clinically. A characteristic pattern of symmetrical, extracapsular inflammation, adjacent to greater trochanter, acetabulum, ischial tuberosity and/or symphysis pubis, was observed in 14/22 of the PMR cases. In PMR, this pattern was associated with complete glucocorticoid response (p=0.01), higher pretreatment C-reactive protein (CRP) and serum interleukin-6 (IL-6), and better post-treatment fatigue and function. Only 1/14 in the extracapsular group could stop glucocorticoids within 1 year, compared with 4/7 of the others. A score derived from the five sites discriminating best between PMR and RA correlated with IL-6 (p<0.002). IL-6 levels ≥16.8 pg/mL had 86% sensitivity and 86% specificity for the extracapsular MRI pattern.

CONCLUSIONS:

A subset of patients with rheumatologist-diagnosed PMR had a characteristic, extracapsular pattern of MRI inflammation, associated with elevated IL-6/CRP and with complete patient-reported glucocorticoid responsiveness.

KEYWORDS:

Cytokines; Magnetic Resonance Imaging; Polymyalgia Rheumatica

PMID:
26376658
PMCID:
PMC4680120
DOI:
10.1136/annrheumdis-2015-207395
[Indexed for MEDLINE]
Free PMC Article

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