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Ultrasonographic monitoring of response to therapy in polymyalgia rheumatica
  1. M Jiménez-Palop1,
  2. E Naredo2,
  3. L Humbrado3,
  4. J Medina4,
  5. J Uson5,
  6. F Francisco6,
  7. M J García-Yebenes7,
  8. J Garrido8
  1. 1Department of Rheumatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
  2. 2Department of Rheumatology, Hospital Severo Ochoa, Madrid, Spain
  3. 3Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
  4. 4Department of Rheumatology, Hospital del Río Carrión, Palencia, Spain
  5. 5Department of Rheumatology, Hospital de Móstoles, Madrid, Spain
  6. 6Department of Rheumatology, Hospital Dr Negrín, Las Palmas de Gran Canarias, Spain
  7. 7Research Unit, Spanish Foundation of Rheumatology, Madrid, Spain
  8. 8Department of Methodology, Universidad Autónoma de Madrid, Madrid, Spain
  1. Correspondence to Dr Mercedes Jiménez-Palop, Hospital Universitario Puerta de Hierro Majadahonda, Martin Iriarte 59, Madrid 28290, Spain; mjimenezp.hpth{at}


Objective To assess the responsiveness of ultrasound (US) inflammatory findings in the shoulder and hip of patients with polymyalgia rheumatica (PMR) who started treatment with corticosteroids.

Methods Fifty-three patients with active PMR who started treatment with prednisone in six Spanish centres were prospectively studied. The patients underwent clinical, laboratory and US assessment at baseline, 4 and 12 weeks. The US investigation consisted of detection and quantification of inflammatory findings in the shoulder and hip. The responsiveness of clinical, laboratory and US parameters was tested by the standardised response mean. Intraobserver and interobserver reliability between US investigators was assessed.

Results At baseline, 34 patients (69%) had inflammation in at least one bilateral site. During the follow-up period, clinical, laboratory and US variables showed a parallel decrease. A significant decrease in US inflammatory parameters was found at week 4 (p<0.001). After 4 and 12 weeks of treatment with corticosteroids, US inflammatory findings showed similar or better sensitivity to change than clinical and laboratory markers of PMR activity. Intraobserver and interobserver intraclass correlation coefficients were 0.96 and 0.99, respectively (p<0.05).

Conclusion US may be a responsive additional tool in monitoring the response to corticosteroids in patients with PMR in daily practice and multicentre trials.

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  • Ethics approval This study was conducted with the approval of the ethics committee, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain and written consent was obtained from all patients.

  • Provenance and peer review Not commissioned; externally peer reviewed.