Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Utility of Ultrasound in the Diagnostic Assessment of Shoulder Pain in Polymyalgia Rheumatica: Results from an International, Prospective, Multi-Center Longitudinal Study. ACREULAR Study Group for Development of Classification Criteria for PMR.

Schmidt17,  Wolfgang A., Cimmino9,  Marco A., Mandl18,  Peter, Balint1,  Peter V., Iagnocco22,  Annamaria, Wakefield20,  Richard J., Schirmer4,  Michael

3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest
Department of Rheumatology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
Department of Rheumatology, Medical University, Graz, Graz, Austria
Department of Rheumatology, Princess Alexandra Hospital, Harlow, United Kingdom
Department of Rheumatology, Southend University Hospital, Essex, United Kingdom
Department of Systemic Autoimmune Hospital Clinic Provincial, Barcelona, Spain
Deptartment of Internal Medicine and Rheumatology, WIM CSK MON, Warszawa, Poland
Immanuel Krankenhaus Berlin: Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany
National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
Radiology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
Center for Diagnosis Imaging, Hospital Clínic, Montserrat del Amo, Barcelona, Spain
Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
Rheumatology Associates of North Jersey, Teaneck, NJ
Rheumatology Unit, Clinica e Terapia Medica Department, Sapienza Università di Roma, Policlinico Umberto I, Rome, Italy
Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
Department of Health Sciences Research, Mayo Clinic, Rochester, MN
Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria
Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Jacksonville, FL
Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN
Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Scottsdale, AZ
Department of Internal Medicine, General Hospital of the Elisabethinen, Klagenfurt, Austria
Department of Internal Medicine, University of Genova, Genova, Italy

Objective:

To evaluate the performance of musculoskeletal ultrasound (US) in the initial assessment and follow up of patients over the age of 50 years presenting with recent onset bilateral shoulder pain.

Methods:

US of shoulder and hips was performed in 89 patients with an initial diagnosis of new onset PMR, 117 control subjects with newly diagnosed conditions mimicking PMR presenting with recent onset of bilateral shoulder pain (includes 37 subjects with new onset rheumatoid arthritis (RA), 30 subjects with other shoulder conditions) and 21 controls without shoulder conditions. All subjects were >=50 years of age. US evaluations were performed using a standardized protocol developed as part of a 6-month prospective study and included assessment of subdeltoid bursitis, biceps tenosynovitis, glenohumeral or hip synovitis and trochanteric bursitis. A preceding training and standardization exercise of US operators at different sites in the study demonstrated very good intercenter comparability of results.

Results:

Patients with PMR were more likely to have abnormal US findings in the shoulder (particularly subdeltoid bursitis and biceps tenosynovitis), and somewhat more likely to have abnormal findings in the hips than control subjects as a group. PMR could not be distinguished from RA on the basis of US, but could be distinguished from non-RA shoulder conditions and subjects without shoulder conditions.

Ultrasound FindingsPMR(N = 89)Controlswith shoulderconditions (N = 117)RA with shoulderinvolvement(N = 37)Non-RA ShoulderCondition(N = 30)Controlswithout shoulderconditions (N = 21)
at least ONE shoulder with subdeltoid bursitis, biceps teno-synovitis or glenohumeral synovitis85%72%*84%63%**19%**
BOTH shoulders with subdeltoid bursitis, biceps teno-synovitis or glenohumeral synovitis62%49%73%27%**0%**
at least ONE shoulder with subdeltoid bursitis or biceps tenosynovitis84%67%**76%57%**19%**
BOTH shoulders with subdeltoid bursitis or biceps tenosynovitis60%43%*60%23%**0%**
at least ONE hip with synovitis or trochanteric bursitis35%20%*23%9%*0%**
BOTH hips with synovitis or trochanteric bursitis17%9%5%3%0%*
at least ONE shoulder and ONE hip with findings as above33%15%**19%7%**0%**
BOTH shoulder and BOTH hips with findings as above10%8%5%3%0%
*p < 0.05;
*p < 0.01 compared to PMR

Conclusions:

In this largest and first multicenter study of US in PMR, most subjects with PMR have abnormal findings on shoulder US. US had limited value in distinguishing PMR from RA, but had value in discriminating PMR from other conditions associated with shoulder pain. US of the shoulders and hips may have added value for diagnosis of PMR.

To cite this abstract, please use the following information:
Schmidt, Wolfgang A., Cimmino, Marco A., Mandl, Peter, Balint, Peter V., Iagnocco, Annamaria, Wakefield, Richard J., et al; Utility of Ultrasound in the Diagnostic Assessment of Shoulder Pain in Polymyalgia Rheumatica: Results from an International, Prospective, Multi-Center Longitudinal Study. ACREULAR Study Group for Development of Classification Criteria for PMR. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1637
DOI: 10.1002/art.29402

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