Rheumatologic disorders

MRI May Improve the Diagnosis of Polymyalgia Rheumatica

Gadolinium-enhanced magnetic resonance imaging (MRI) of the shoulders may aid in the accurate diagnosis of polymyalgia rheumatica (PMR), as well as predict PMR recurrence, according to a new study presented at the 2019 American College of Rheumatology (ACR)/Association of Rheumatology Professionals (ARP) Annual Meeting.

Ultrasonography of the shoulders can detect biceps tenosynovitis and subdeltoid bursitis in patients with PMR. However, challenges remain, since its symptoms can occur in numerous rheumatologic and inflammatory conditions.

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“The diagnostics of PMR remain challenging. We need more careful diagnostic tools for patients with PMR,” Kazuro Kamada, MD, said during a press conference at the ACR/ARP Annual Meeting.

To evaluate whether gadolinium-enhanced MRI could improve diagnostic accuracy and prognosis prediction in patients with PMR, Dr Kamada and colleagues analyzed data on 175 consecutive patients who were seen at Tomakomai City Hospital in Tomakomai, Japan, between June 2012 and June 2018. All patients had complained of bilateral shoulder pain and met the Bird classification criteria for PMR.

In all, 137 patients underwent gadolinium-enhanced MRI and ultrasonography. PMR was diagnosed in 58 patients by at least 2 rheumatologists. Each patient with PMR received prednisolone, 20 mg daily, which was tapered following remission.

The findings observed via MRI included the following:

 

  • Enhancement of the joint capsule, rotator cuff tendon, biceps tendon, or glenohumeral joint
  • Synovial hypertrophy
  • Shoulder joint effusion
  • Focal or diffuse bone edema in the head of the humerus

 

Of these MRI findings, enhancement of joint capsule or rotator cuff tendon and focal bone edema in the head of the humerus were significantly frequent in the patients with PMR. When the researchers used the combination of these 3 MRI findings to diagnose PMR, they noted 76% sensitivity and 85% specificity, which was higher than the 50% sensitivity and 72% specificity of the ultrasonography findings.

In the follow-up study, 24 patients (44%) had recurrent PMR. These patients were younger, had less enhancement of the rotator cuff tendon, and had more synovial hypertrophy findings on MRI.

“Gadolinium-enhanced MRI displayed capsulitis, rotator cuff tendonitis and focal osteitis in shoulders, relatively specific to patients with PMR,” the researchers concluded. “Our study suggested that gadolinium-enhanced MRI in shoulders could contribute accurate diagnosis and predicting recurrence to patients with PMR.”

Kamada said that gadolinium-enhanced MRI may be useful, and rheumatologists can consider using it in PMR. However, rheumatologists should also keep in mind the high costs of gadolinium-enhanced MRI and the potential for any effects from gadolinium on patients.

—Colleen Murphy

Reference:

Kamada K, Nakamura H, Tarumi M, Tanimura S, Horita T. Gadolinium-enhanced magnetic resonance imaging in shoulders contributes accurate diagnosis and predicting recurrence to patients with polymyalgia rheumatica [abstract 1161]. Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. https://acrabstracts.org/abstract/gadolinium-enhanced-magnetic-resonance-imaging-in-shoulders-contributes-accurate-diagnosis-and-predicting-recurrence-to-patients-with-polymyalgia-rheumatica/. Accessed November 10, 2019.