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Whole-body MRI of patients with polymyalgia rheumatica identifies a distinct subset with complete patient-reported response to glucocorticoids
  1. Sarah Louise Mackie1,2,
  2. Colin Thomas Pease3,
  3. Eiji Fukuba4,
  4. Emma Harris1,
  5. Paul Emery1,2,
  6. Richard Hodgson1,2,5,
  7. Jane Freeston1,2,
  8. Dennis McGonagle1,2
  1. 1Leeds Institute for Rheumatic and Musculoskeletal Medicine, Leeds, UK
  2. 2NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
  3. 3Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Department of Radiology, Shimane University, Izumo, Japan
  5. 5University of Manchester Centre for Imaging Sciences, Manchester, UK
  1. Correspondence to Dr Sarah Louise Mackie, Leeds Institute for Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds LS7 4SA, UK; s.l.mackie{at}leeds.ac.uk

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.

  • Magnetic Resonance Imaging
  • Polymyalgia Rheumatica
  • Cytokines

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