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Cervical interspinous bursitis in active polymyalgia rheumatica

C Salvarani¹, L Barozzi², F Cantini³, L Niccoli³, L Boiardi¹, M Valentino², N Pipitone¹, G Bajocchi¹, P Macchioni¹, M G Catanoso¹, I Olivieri⁴, G G Hunder⁵

¹ Divisione di Reumatologia, Arcispedale S Maria Nuova, Reggio Emilia, Italy
² Radiologia Diagnostica, Ospedale S Orsola-Malpighi, Bologna, Italy
³ II Divisione di Medicina, Unitè Reumatologica, Ospedale di Prato, Prato, Italy
⁴ Dipartimento di Reumatologia, Ospedale S Carlo, Potenza e Ospedale Madonna delle Grazie, Matera, Italy
⁵ Mayo Clinic, Rochester, Minnesota, USA

Dr C Salvarani, Unitè Operativa di Reumatologia, Arcispedale S Maria Nuova, V le Risorgimento N80, 42100 Reggio Emilia, Italy; salvarani.carlo{at}asmn.re.it

Objective: To evaluate the inflammatory involvement of cervical interspinous bursae in patients with polymyalgia rheumatica (PMR) using MRI.

Methods: In all, 12 consecutive, untreated new patients with PMR were investigated. Five patients with fibromyalgia, two patients with cervical osteoarthritis and six patients with spondyloarthritis with neck pain served as controls. MRI of the cervical spine was performed in all 12 PMR case patients and in 13 control patients. Two of the four patients with PMR with pelvic girdle pain also had MRI of the lumbar spine.

Results: MRI evidence of interspinous cervical bursitis was found in all patients with PMR, and in three patients with fibromyalgia, in two with psoriatic spondylitis and one with cervical osteoarthritis. A moderate to marked (grade 2 on a semiquantitative 0–3 scale) cervical bursitis occurred significantly more frequently in patients with PMR than in control patients (83.3% compared with 30.7%, p = 0.015). In all patients and controls with cervical bursitis the involvement was found at the C5–C7 cervical interspaces. MRI of the lumbar spine showed lumbar interspinous bursitis at the L3–L5 lumbar interspaces in the two patients with PMR and pelvic girdle pain examined.

Conclusions: Cervical interspinous bursitis is a likely basis for discomfort in the neck of patients with PMR. The prominent inflammatory involvement of cervical bursae supports the hypothesis that PMR is a disorder of prominent involvement of extra-articular synovial structures.

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Relevant Article

The clinical implication of cervical interspinous bursitis in the diagnosis of polymyalgia rheumatica

Miguel A Gonzalez-Gay
Ann Rheum Dis 2008 67: 733-734. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Gonzalez-Gay, M. A (2008). The clinical implication of cervical interspinous bursitis in the diagnosis of polymyalgia rheumatica. Ann Rheum Dis 67: 733-734 [Full Text]