AB1288 US IMAGING IN THE DIAGNOSIS AND MANAGEMENT OF POLYMYALGIA RHEUMATICA
Authors: A. El Miedany, Y. El Miedany, M. Elgaafary, W. Elwakil, S. A. Mahran, A. N. Mehanna, W. Hassan, M. H. Abu-Zaid
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Ultrasound (US) is a valuable diagnostic tool in polymyalgia rheumatica (PMR) for detecting typical pathologies at shoulders and hips including subdeltoid bursitis, biceps tenosynovitis, shoulder and hip joint effusion, and trochanteric bursitis. Ultrasound helps in excluding diseases mimicking PMR such as shoulder osteoarthritis or rotator cuff tendinitis. <h3>Objectives:</h3> 1. to assess the prevalence of sonographic pathologic findings in a cohort of patients newly diagnosed to have PMR. 2. To determine if there is association between the persistence of inflammation at US and relapses/recurrences of PMR symptoms. 3. To assess the correlation between disease activity biomarkers and US pathologic findings in PMR patients <h3>Methods:</h3> Study design: Cross sectional Retrospective analysis of consecutive patients newly diagnosed with PMR without symptoms or signs of GCA. Patients: PMR patients diagnosed according to the ACR/EULAR criteria. Methodology: Data from 74 consecutive recently diagnosed untreated PMR patients were included for the purpose of this study. All the patients were assessed at baseline as well as at 2, 4-,12- and 24 weeks. Clinical symptoms and inflammatory markers: ESR and CRP were assessed and recorded. The PMR-activity score (PMR-AS) was calculated as: CRP (mg/dl)+VAS patient (0–10)+VAS physician (0–10)+(Morning stiffness (min)×0.1)+Elevate upper limb (3–0) [Elevate upper limb: EUL (3 = none, 2 = below shoulder girdle, 1 = up to shoulder girdle, 0 = above shoulder girdle). PMR-AS between 17 and 7 was regarded as the range for medium disease activity, &gt;17 for high, and &lt;7 for low disease activity. US examination (both Gray Scale and Power Doppler) of the shoulders and hips was performed in all the patients at diagnosis and after the onset of prednisone treatment (2-, 4-, 12- and 24-weeks). Shoulder and hip sonograms were obtained according to standardized techniques. <h3>Results:</h3> Mean (SD) age was 68.7 (4.9) years and 41/74 (55.4%) patients were female. Pathologic US findings were reported in 69/74 (93.2%). At diagnosis, a positive PD signal was observed more frequently in the subacromial/subdeltoid bursae (26/74 35.1%). Table 1 shows the prevalence of the US pathologic findings. Prednisone therapy reduced significantly the frequency of patients with positive US GS and PD signals by the 2nd week (30/74, 40.5%), at 4-weeks (51/75, 68.9%), at 12-weeks (57/74, 77%) and at 24-weeks (64/74, 86.5%). There was no association between the persistence of inflammation at US and relapses/recurrences. Local US pathologies responded very well to local steroid injections. No significant correlations between disease activity biomarkers and US findings were identified at 2-, 12- and 24-weeks. Concerning the reproducibility, the intra-observer and inter-observer reliability of US assessment in PMR patients was excellent (k values 0.96 and 0.97, respectively) for both assessments. <h3>Conclusion:</h3> There is relevant role of US as a diagnostic and monitoring tool for PMR. US findings of bilateral shoulder abnormalities (Subdeltoid bursitis/Long Head Biceps (LHB) tenosynovitis/Glenohumeral Joint (GHj) effusion) or abnormalities in one shoulder and hip (hip effusion, trochanteric bursitis) are indicative of PMR diagnosis. Extra-articular involvement was the most relevant finding at both shoulders and hips. Sonographic findings seem not able to predict the occurrence of disease relapses, yet, it can help in tailoring the treatment to the individual patient's requirement and guiding the local injection. <b>Table 1.</b> Prevalence of the US pathologic findings in patients with PMR <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>