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FRI0392 Ultrasonographic Scoring Revealed That The Ratio of Extra-Synovial Inflammation To Synovial Inflammation in The Shoulder Is Higher in PMR Patients than That in Elderly-Onset RA Patients with PMR-like Onset
  1. T. Suzuki,
  2. R. Yoshida,
  3. Y. Seri
  1. Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan


Background We previously reported that shoulder synovitis in polymyalgia rheumatica (PMR) is milder than that in elderly-onset rheumatoid arthritis (EORA) patients with PMR-like onset (polymyalgic-EORA) by using semi-quantitative ultrasound (US) scoring of the synovial components in the shoulder in spite of the higher serum CRP (1).

Objectives We aimed to evaluate the contribution of the extra-synovial inflammation in PMR patients by power Doppler (PD) US.

Methods We analyzed US records of 14 untreated PMR patients and 14 untreated polymyalgic-EORA patients using a semi-quantitative four-point scale (0 = absent, 1 = mild, 2 = moderate or 3 = severe). For the comprehensive evaluation of shoulder synovitis, the severity of the biceps tenosynovitis, subacromial/subdeltoid bursitis and glenohumeral joint synovitis were subjectively scored on a gray scale and by PD on a 4-point scale (0–3). The sum of six scores (0–18) for one shoulder was defined as shoulder synovitis score (SSS). For the evaluation of extra-synovial inflammation in the shoulder, the hyperemia adjacent to the anterior aspect of the subscapularis tendon (SubST) was analyzed in the horizontal long axis view. The severity of PD-signals on SubST was subjectively scored on a 4-point scale (0–3) as exemplified in the figure, and the score was defined as the extra-synovial hyperemia score (ESHS).

Results The ESHS/SSS ratio was significantly higher in PMR shoulders than in polymyalgic-EORA shoulders (0.447 ±0.251 vs 0.303 ±0.277, p=0.0138). The bilateral ESHS/bilateral SSS ratio was significantly higher in PMR patients than in polymyalgic-EORA patients (0.475 ±0.269 vs 0.236 ±0.182, p=0.00776).

Conclusions Semi-quantitative US scoring of the synovial and the extra-synovial components in the shoulder revealed the larger involvement of the extra-synovial soft tissue inflammation in PMR patients than in EORA patients with PMR-like onset.

  1. Arthritis Rheumatol. 2015; 67 (suppl 10)

Disclosure of Interest None declared

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