Ultrasound imaging for the rheumatologist XLIII. Ultrasonographic evaluation of shoulders and hips in patients with polymyalgia rheumatica: A systematic literature review

Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. .
Clinical and experimental rheumatology (Impact Factor: 2.72). 02/2013; 31(1):1-7.
Source: PubMed


Musculoskeletal ultrasonography (US) has lately been applied to patients with polymyalgia rheumatica for the examination of shoulders and hip, and included in the 2012 PMR classification criteria. We aimed to perform a comprehensive overview of the literature on this topic with a systematic review.

We searched PubMed, Embase, the Cochrane library and the proceedings from EULAR and ACR congresses (2011-2012). We included studies evaluating patients with confirmed or suspected PMR, undergoing US of shoulders and/or hips. The diagnosis of PMR could be based on expert opinion or diagnostic criteria. Cohort, case-control, diagnostic accuracy studies and case-series were eligible for inclusion. The features of the included studies were presented. When available, sensitivities and specificities were calculated for primary studies.

Out of 1736 papers identified by our search, 13 articles and 1 abstract were finally included in the review. Eight studies focused on shoulder US, 1 on hip US, 4 on both. Studies were extremely variable in terms of population, US examination, reference standard and control population. In general, at the shoulder, pathological bilateral US findings in most studies were more prevalent in patients with PMR compared to controls. When sensitivity and specificity could be calculated, bilateral findings were more sensitive. Notably, less information was available on hip US.

US (especially in shoulder examination) is confirmed to be a potentially useful instrument to integrate clinical information in the management of patients with PMR. Its additional value in conjunction with the new classification criteria should be further tested.

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  • No preview · Article · Dec 2013 · BMJ (online)
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    ABSTRACT: Ultrasonography (US) is widely used in the diagnosis of rheumatic conditions, and its value for the classification criteria of rheumatic diseases has been recently suggested. According to the EULAR/ACR provisional criteria for polymyalgia rheumatica, adding US to the clinical and serological features will significantly improve the sensitivity of proposed criteria. The ability of high resolution US to detect crystalline deposits of monosodium urate in joints and soft tissues is well recognized. For the first time, the new 2014 ACR/EULAR set of proposed criteria for gout includes advanced imaging techniques for the detection of disease: US and dual-energy computed tomography. Due to low costs and affordability, use of US evaluation for patients with suspected gout will increase both specificity and sensibility of classification criteria. The recent inclusion of US in the classification criteria of various rheumatic diseases, such as PMR and gout, implies that this imaging technique is not only useful as a valued diagnostic tool for individual cases, but also on a larger scale, it will improve doctors' ability to classify diseases. Its use is thus changing our understanding of rheumatic diseases allowing further advances in research and clinical practice.
    Preview · Article · Mar 2015 · Medical ultrasonography
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    ABSTRACT: Polymyalgia rheumatica (PMR) is a common inflammatory rheumatism in the elderly. It is characterized by inflammatory pain of scapular and pelvic area. In the absence of biological signature, these symptoms may be non-specific and therefore discuss other diagnoses in the elderly. In this context, ultrasound has been developed, in order to assist in the diagnosis and monitoring of treatment. Thus, since 2012, the new classification criteria EULAR 2012 include ultrasonography. In particular, the following abnormalities will be searched: at least one shoulder (subdeltoid bursitis, biceps tenosynovitis or glenohumeral synovitis), and at least one hip (hip joint synovitis or trochanteric bursitis) ; or bilateral involvement of the shoulders. These abnormalities are not specific of PMR, but their presence will have more value if the clinical and biological context is suggestive, especially in case of bilateral abnormalities. This is an easily, non-invasive and accessible examination. Its intra- and inter-observer reproducibility seems excellent. Moreover, its quite good sensitivity to change could make it a useful tool for the monitoring of treatment.
    No preview · Article · Sep 2015 · Revue du Rhumatisme Monographies