Mackie, SL orcid.org/0000-0003-2483-5873, Pease, CT, Fukuba, E et al. (5 more authors) (2015) Whole-body MRI of patients with polymyalgia rheumatica identifies a distinct subset with complete patient-reported response to glucocorticoids. Annals of the Rheumatic Diseases, 72 (12). pp. 2188-2192. ISSN 0003-4967
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, untreated and diagnosed by consultant rheumatologists, underwent whole-body, multiple-joint MRI, scored by two experts. PMR patients reported whether they felt “back to normal” on glucocorticoid therapy and were followed for a median of 2 years.
Results: All PMR patients 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 pre-treatment C-reactive protein (CRP) and serum IL-6, and better post-treatment fatigue and function. Only 1/14 in the extracapsular group could stop glucocorticoids within 1 year, compared to 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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | (c) 2015, The Author(s). This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. |
Keywords: | Magnetic resonance imaging, polymyalgia rheumatica |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Experimental Musculoskeletal Medicine (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Inflammatory Arthritis (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 14 Oct 2015 13:25 |
Last Modified: | 23 Jun 2023 21:50 |
Published Version: | http://dx.doi.org/10.1136/annrheumdis-2015-207395 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Identification Number: | 10.1136/annrheumdis-2015-207395 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:88548 |