Clinical characteristics of polymyalgia rheumatica in Japanese patients: evidence of synovitis and extracapsular inflammatory changes by fat suppression magnetic resonance imaging

Abstract

Polymyalgia rheumatica (PMR) is an inflammatory condition of unknown etiology characterized by diffuse pain and morning stiffness involving neck, shoulder, and pelvic girdles. To facilitate an understanding of PMR and its proper diagnosis, we evaluated clinical symptoms, laboratory data, and radiographic findings of 32 Japanese patients with it. Distal musculoskeletal manifestations were more frequently observed than had been thought before (81% of the patients), and peripheral arthritis was most common (75%). The joints most often affected were knees and wrists, and most episodes were presented as bilateral oligo- or polyarthritis. A swelling of hands was observed in 34% of the patients. Using contrast-enhanced fat suppression magnetic resonance imaging (MRI) of the shoulder, we found the evidence of subacromial and subdeltoid bursitis (100%), glenohumeral joint synovitis (93%), and biceps tenosynovitis (57%) in the PMR patients examined. Inflammatory changes in soft tissues around the joint capsule were prominent. By knee MRI, suprapatellar bursitis and joint synovitis were visualized in all cases examined, and extracapsular abnormalities were also prominent in 90% of the patients. Serum matrix metalloproteinase-3, a parameter of synovial inflammation, was significantly increased in PMR patients. Anticyclic citrullinated peptide antibody was useful for differential diagnosis between PMR and elderly onset rheumatoid arthritis. In conclusion, joint and periarticular synovitis seems to be commonly and primarily responsible for the proximal and distal musculoskeletal symptoms of PMR. The presence of the extracapsular change, probably a nonspecific extension of synovitis, can explain the severe discomfort that radiates toward the periphery. To avoid making a wrong diagnosis, we should be aware that peripheral synovitis is one of the hallmarks of PMR.

Induction of Remission is Difficult due to Frequent Relapse during Tapering Steroids in Korean Patients with Polymyalgia Rheumatica

“…In addition, the frequencies of thrombocytosis and hypoalbuminemia were high. Frequencies of positive RF and ANA were higher than in previous reports (15, 23). However, their titers of RF were low.…”

“…In this study, the mean age at disease onset was 67.4 yr, and 70.6% of patients were women, similar to previous studies (19, 20). Table 4 shows a summary of the clinical and laboratory data of Korean patients, compared to those reported in Caucasian (21), Chinese (17), and Japanese patients (15). Shoulder girdle pain, weight loss, and depression were prevalent symptoms, similar to other reports (15-17, 21).…”

“…Table 4 shows a summary of the clinical and laboratory data of Korean patients, compared to those reported in Caucasian (21), Chinese (17), and Japanese patients (15). Shoulder girdle pain, weight loss, and depression were prevalent symptoms, similar to other reports (15-17, 21). Incidences of morning stiffness and peripheral arthritis were lower; however, the incidence of hip girdle pain was higher.…”

“…Data on the disease course, clinical features, and outcome of PMR have been described in various parts of the world (15-18). However, data on the disease course, ultimate outcome, and therapeutic response of PMR in Korea are limited.…”

The rate of polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in a clinic where primary care physicians are working in Japan

“…With regard to the reports on PMR in Japan, there are some clinical studies on patients with PMR. For example, five independent research groups demonstrated clinical features in 29, 13, 7, 44, or 32 patients with PMR in Japan, respectively [11–15]. Thus, PMR is observed commonly in Japan.…”