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. 2022 Nov-Dec;55(6):346-352.
doi: 10.1590/0100-3984.2021.0151.

Magnetic resonance imaging findings in patients with polymyalgia rheumatica

Renata Vidal Leão  1   2 , Ana Luisa Garcia Calich  1 , Isidio Calich  1 , Marcelo Bordalo Rodrigues  1   2 , Paulo Victor Partezani Helito  1   2 , Denise Tokechi Amaral  1 , Renata Fernandes Batista Pereira  1 , Marcos Felippe de Paula Correa  1
Affiliations

Magnetic resonance imaging findings in patients with polymyalgia rheumatica

Renata Vidal Leão et al. Radiol Bras. 2022 Nov-Dec.

Abstract
in English, Portuguese

Objective: To describe the prevalence of magnetic resonance imaging (MRI) findings in patients with the clinical diagnosis of polymyalgia rheumatica (PMR).

Materials and methods: Sixteen consecutive patients with untreated PMR, meeting the American College of Rheumatology criteria, underwent MRI examinations of the shoulder(s), hip(s), or both, depending on clinical complaints. Six patients also underwent MRI of the spine.

Results: We evaluated 24 shoulders, among which we identified subacromial-subdeltoid bursitis in 21 (87.5%), glenohumeral joint effusion in 17 (70.8%), and fluid distention of the long head of the biceps tendon sheath in 15 (62.5%). Peritendinitis and capsular edema were observed in 21 (87.5%) and 17 (70.8%) shoulders, respectively. We also evaluated 17 hips, identifying hip joint effusion in 12 (70.6%), trochanteric bursitis in 11 (64.7%), peritendinitis in 17 (100%), and capsular edema in 14 (82.4%). All six of the patients who underwent MRI of the spine were found to have interspinous bursitis.

Conclusion: Subacromial-subdeltoid bursitis, glenohumeral joint effusion, and hip joint effusion are common findings in patients with PMR. In addition, such patients appear to be highly susceptible to peritendinitis and capsular edema. There is a need for case-control studies to validate our data and to determine the real impact that these findings have on the diagnosis of PMR by MRI.

Objetivo: Descrever os achados de ressonância magnética (RM) mais prevalentes em pacientes com diagnóstico clínico de polimialgia reumática (PMR).

Materiais e métodos: Dezesseis pacientes com PMR não tratada, classificados pelos critérios do American College of Rheumatology, foram submetidos a RM do ombro e/ou quadril, segundo suas queixas clínicas. Seis pacientes também foram submetidos a RM da coluna.

Resultados: Foram avaliados 24 ombros, identificando-se bursite subacromial-subdeltoide em 21 (87,5%), sinovite glenoumeral em 17 (70,8%) e distensão líquida da bainha do tendão da cabeça longa do bíceps em 15 (62,5%). Peritendinite e edema capsular foram observados em 21 (87,5%) e 17 (70,8%) ombros, respectivamente. Dezessete quadris foram analisados, identificando-se sinovite em 12 (70,6%), bursite trocantérica em 11 (64,7%), peritendinite em 17 (100%) e edema capsular em 14 (82,4%). Os seis pacientes que realizaram RM da coluna apresentavam bursite interespinhosa.

Conclusão: Bursite subacromial-subdeltoide, sinovite glenoumeral e do quadril são achados de imagem prevalentes em pacientes com PMR. Além disso, achados como peritendinite e edema capsular tiveram alta prevalência nesses pacientes. Estudos de casocontrole devem ser realizados para validar esses dados e estabelecer o real impacto desses achados no diagnóstico de PMR.

Keywords: Hip joint/pathology; Magnetic resonance imaging/ methods; Polymyalgia rheumatica/diagnostic imaging; Shoulder joint/pathology.

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Figures

Figure 1
Figure 1
MRI of the left shoulder in a 70-year-old male with PMR. A: Coronal T2wFS image showing mild joint effusion with marked capsular and pericapsular soft-tissue edema (arrow). Note also the supraspinatus peritendinitis (asterisks). B: Axial T2wFS image showing effusion around the LHB tendon (arrowhead). C: Sagittal T2wFS image showing peritendinitis involving the supraspinatus muscle (short arrow) and subscapularis muscle (long arrow).
Figure 2
Figure 2
MRI of the right shoulder in a 60-year-old female with PMR. A: Coronal T2wFS image showing joint effusion (arrow) and a small amount of fl uid distending the SASD bursa (arrowheads). B: Sagittal T2wFS image showing peritendinitis involving the teres minor tendon and muscle (arrow). C: Axial T2wFS image showing peritendinitis involving the infraspinatus muscle (long arrow) and subscapularis muscle (short arrow).
Figure 3
Figure 3
MRI of the right hip in a 58-year-old female with PMR. A: Sagittal T2wFS image showing capsular and pericapsular soft-tissue edema (arrows). B: Contrast-enhanced coronal T1-weighted fat-saturated sequence showing diffuse enhancement of the joint capsule (arrows).
Figure 4
Figure 4
MRI of the hips in a 72-year-old female with PMR. A: Coronal T2wFS image showing peritendinitis involving the fascia lata tendon (arrows). B: Axial T2wFS image showing capsular and pericapsular soft-tissue edema (arrows).
Figure 5
Figure 5
MRI of the lumbar spine in a 70-year-old patient with PMR. A: Sagittal T2wFS image showing edema and bursitis of the interspinous ligaments (arrows). B: Contrast-enhanced sagittal T1-weighted fat-saturated sequence showing marked enhancement of the interspinous ligaments (arrows).
See this image and copyright information in PMC

References

    1. Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012;64:943–954. - PubMed
    1. Crowson CS, Matteson EL. Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015. Semin Arthritis Rheum. 2017;47:253–256. - PMC - PubMed
    1. Doran MF, Crowson CS, O’Fallon WM, et al. Trends in the incidence of polymyalgia rheumatica over a 30 year period in Olmsted County, Minnesota, USA. J Rheumatol. 2002;29:1694–1697. - PubMed
    1. Crowson CS, Matteson EL, Myasoedova E, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum. 2011;63:633–639. - PMC - PubMed
    1. Ceccato F, Roverano SG, Papasidero S, et al. Peripheral musculoskeletal manifestations in polymyalgia rheumatica. J Clin Rheumatol. 2006;12:167–171. - PubMed