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Expression of interleukin-6 in synovial tissue of patients with polymyalgia rheumatica
  1. William F Jiemy1,
  2. Anqi Zhang1,
  3. Annemieke M H Boots1,
  4. Peter Heeringa2,
  5. Maria Sandovici1,
  6. Arjan Diepstra2,
  7. Sandra Hein3,
  8. Bhaskar Dasgupta4,
  9. Elisabeth Brouwer1,
  10. Kornelis SM van der Geest1
  1. 1Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  3. 3Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  4. 4Department of Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
  1. Correspondence to Dr Kornelis SM van der Geest, Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands; k.s.m.van.der.geest{at}umcg.nl

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Polymyalgia rheumatica (PMR) is a common, rheumatic inflammatory disease causing debilitating pain and stiffness of the shoulder and hip girdle.1 Inflammation of bursae and tendon sheaths is a key finding in PMR. Glucocorticoids have remained the mainstay of treatment for 60 years. Alternative treatments for PMR are highly needed, since half of patients require prolonged treatment, which is associated with substantial toxicity.1 2 A recent phase 2/3 trial has shown promising efficacy of anti-interleukin (IL)−6 receptor (antil-IL-6R) therapy for new-onset PMR3: 63% of patients treated with anti-IL-6R therapy reached glucocorticoid-free remission at week 16, whereas 12% of placebo-treated patients reached this primary end point. The biological rationale for targeting the IL-6 pathway stems from the observation that serum levels of IL-6 are increased in PMR.2 4 However, it is unclear whether IL-6 is also expressed in the tissues affected by PMR.

We investigated the expression of IL-6 in synovial tissue obtained from six patients with new-onset, treatment-naïve PMR (four women; median age 72 years, range 58–79) showing subacromial-subdeltoid (SASD) bursitis on ultrasonography. The median erythrocyte sedimentation rate at the time of the biopsy collection was 67 mm/hour (range 39–89) and serum C reactive protein was 67 mg/L (range 3–118). All patients fulfilled the Chuang criteria for PMR.1 Their diagnosis was confirmed after 6 months of follow-up and concomitant large-vessel giant cell arteritis was ruled out by vascular ultrasonography and/or FDG-PET/CT. Synovial tissue was …

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Footnotes

  • Handling editor Josef S Smolen

  • Twitter @jiemy_william

  • Collaborators n/a.

  • Contributors WFJ, BD, EB and KSMvdG contributed to conception or design of the work. WFJ, AZ, AD, SH, KSMvdG contributed to acquisition of data. All authors contributed to analysis or interpretation of data. All authors were involved in drafting of the work or revising it critically for important intellectual content. All authors provided final approval of the version published. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The study was supported by a research grant from FOREUM Foundation for Research in Rheumatology. The study was also funded by the Rheumatology Grant (Dutch Society for Rheumatology) and Mandema Stipend (University Medical Center Groningen).

  • Competing interests KSMvdG reports personal fees from Roche, outside the submitted work. BD reports consulting fees from Roche, Chugai, Sanofi, and sponsorship grants for international meetings and workshops with Roche, Sanofi, AbbVie and GlaxoSmithKline. EB reports personal fees from Roche, outside the submitted work. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Advice on the feasibility and relevance of the study was obtained from patients through the Vasculitis Stichting and PMRGCAuk.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.