Whole-body MRI of patients with polymyalgia rheumatica identifies a distinct subset with complete patient-reported response to glucocorticoids. Issue 12 (16th September 2015)

• Record Type: Journal Article
• Authors: Mackie, Sarah Louise; Pease, Colin Thomas; Fukuba, Eiji; Harris, Emma; Emery, Paul; Hodgson, Richard; Freeston, Jane; McGonagle, Dennis
• Is Part Of: Annals of the rheumatic diseases. Volume 74:Issue 12(2015)
• Page Start: 2188
• Page End: 2192
• Publication Date: 2015-09-16
• Subjects: Magnetic Resonance Imaging -- Polymyalgia Rheumatica -- Cytokines; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2015-207395
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objectives: To determine whether whole-body MRI defines clinically relevant subgroups within polymyalgia rheumatica (PMR) including glucocorticoid responsiveness. Methods: 22 patients with PMR and 16 with rheumatoid arthritis (RA), untreated and diagnosed by consultant rheumatologists, underwent whole-body, multiple-joint MRI, scored by two experts. Patients with PMR reported whether they felt 'back to normal' on glucocorticoid therapy and were followed for a median of 2 years. Results: All patients with PMR were deemed to respond to glucocorticoids clinically. A characteristic pattern of symmetrical, extracapsular inflammation, adjacent to greater trochanter, acetabulum, ischial tuberosity and/or symphysis pubis, was observed in 14/22 of the PMR cases. In PMR, this pattern was associated with complete glucocorticoid response (p=0.01), higher pretreatment C-reactive protein (CRP) and serum interleukin-6 (IL-6), and better post-treatment fatigue and function. Only 1/14 in the extracapsular group could stop glucocorticoids within 1 year, compared with 4/7 of the others. A score derived from the five sites discriminating best between PMR and RA correlated with IL-6 (p<0.002). IL-6 levels ≥16.8 pg/mL had 86% sensitivity and 86% specificity for the extracapsular MRI pattern. Conclusions: A subset of patients with rheumatologist-diagnosed PMR had a characteristic, extracapsular pattern of MRI inflammation, associated with elevated IL-6/CRP and with complete patient-reported glucocorticoid responsiveness.