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Cervical interspinous bursitis in active polymyalgia rheumatica
  1. Carlo Salvarani (salvarani.carlo{at}
  1. Arcispedale S Maria Nuova, Italy
    1. Libero Barozzi (libero.barozzi{at}
    1. Ospedale S. Orsola Malpighi, Italy
      1. Fabrizio Cantini (cantini.fabrizio{at}
      1. Ospedale di Prato, Italy
        1. Laura Niccoli (laura.niccoli{at}
        1. Ospedale di Prato, Italy
          1. Luigi Boiardi (boiardi.luigi{at}
          1. Arcispedale S Maria Nuova, Italy
            1. Massimo Valentini (massimo.valentini{at}
            1. Ospedale S. Orsola Malpighi, Italy
              1. Nicolò Pipitone (pipitone.nicolo{at}
              1. Arcispedale S Maria Nuova, Italy
                1. Gianluigi Bajocchi (baiocchi.gianluigi{at}
                1. Arcispedale S Maria Nuova, Italy
                  1. Pierluigi Macchioni (macchioni.pierluigi{at}
                  1. Arcispedale S Maria Nuova, Italy
                    1. MariaGrazia Catanoso (catanoso.mariagrazia{at}
                    1. Arcispedale S Maria Nuova, Italy
                      1. Ignazio Olivieri (ignazioolivieri{at}
                      1. Ospedale S. Carlo, Italy
                        1. Gene Hunder (ghunder{at}
                        1. Mayo Clinic College of Medicine, Rochester, United States


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

                          Methods: Twelve consecutive, untreated new patients with PMR were investigated. Five patients with fibromyalgia, 2 patients with cervical osteoarthritis and 6 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 4 PMR patients 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 3 patients with fibromyalgia, in 2 with psoriatic spondylitis and 1 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 2 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.

                          • cervical interspinous bursae
                          • inflammation
                          • lumbar interspinous bursae
                          • magnetic resonance imaging
                          • polymyalgia rheumatica

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