Polymyalgia rheumatica: an arthroscopic study of the shoulder joint.

Douglas, William; Martin, Bruce; Morris, James H.

doi:10.1136/ard.42.3.311

Cited by 48 publications

(13 citation statements)

References 12 publications

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“…The presence of proximal articular and periarticular synovitis in PMR has been proven by arthroscopy, 8 synovial biopsy, 9,10 ultrasonography (US), 11,12 scintigraphy, 13 and magnetic resonance imaging (MRI). 14 Using US and MRI of the shoulders, Cantini et al showed that subacromial and subdeltoid (SA-SD) bursal synovitis (= bursitis) is the most frequent and unique lesion present in almost all PMR patients.…”

Section: Introductionmentioning

confidence: 99%

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

2007

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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.

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Section: Introductionmentioning

confidence: 99%

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

2007

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“…Polymyalgia rheumatica (PMR) is a common inflammatory disease in the elderly, which is characterized clinically by pain and stiffness ascribed to multiple tenosynovitis in the proximal muscles (1)(2)(3). Corticosteroid therapy usually shows good therapeutic effects at a low to moderate dosage within a week after initiation in PMR, but in some cases muscle symptoms persist even though C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) return to the normal range (4,5).…”

Section: Introductionmentioning

confidence: 99%

Serum Amyloid A as a Potent Therapeutic Marker in a Refractory Patient with Polymyalgia Rheumatica

et al. 2005

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“…However, many patients appear to have PMR alone. In recent studies, in¯ammation of the shoulder regions has been demonstrated by arthroscopy and ultrasonography [13,14,20]. The etiology of the synovitis remains elusive; the pathogenesis is thought to be immune-mediated [11].…”

Section: Discussionmentioning

confidence: 98%

Ultrasonography of the glenohumeral joints - a helpful instrument in differentiation in elderly onset rheumatoid arthritis and polymyalgia rheumatica

Lange

Piegsa

Teichmann³

et al. 2000

Rheumatology International

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In a prospective study, the glenohumeral joints of 51 patients (aged 60 or above) were examined, using ultrasonography. Twenty-two patients were suffering from characteristic polymyalgia rheumatica (PMR) symptoms. In contrast, 29 other patients initially had similar complaints, but were diagnosed as having elderly onset rheumatoid arthritis (EORA, rheumatoid factor negative) upon development of typical symptoms. Ultrasound examination revealed glenohumeral joint inflammation in 40.9% (9/22) of the patients with PMR and 65.5% (19/29) of the patients with EORA. A discrete symmetrical biceps tendon sheath effusion was found in only three patients and unilateral in six patients with PMR. In contrast, 12 patients with EORA presented a massive effusion of the biceps tendon sheath, in some cases combined with a bilateral subdeltoid bursitis, and an intraarticular (i.a.) effusion/synovitis. To summarize our results: an i.a. effusion/synovitis, subdeltoid bursitis and biceps tendon sheath effusion were more frequent in patients with EORA, with a predominate symmetry and signs for massive inflammation. The typical ultrasonographic result in patients with PMR was a unilateral inflammation of the glenohumeral joint with predominate discrete biceps tendon sheath effusion and, in comparison with the EORA group, with signs of a low grade inflammation. We conclude that the results of our prospective study might be helpful in the differentiation of PMR and a rheumatoid factor negative subgroup of EORA at the first time of manifestation where clinical overlaps can be observed. However, ultrasonography of the glenohumeral joints might be a good and helpful instrument of differentiation in both diseases.

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Polymyalgia rheumatica: an arthroscopic study of the shoulder joint.

Cited by 48 publications

References 12 publications

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

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

Serum Amyloid A as a Potent Therapeutic Marker in a Refractory Patient with Polymyalgia Rheumatica

Ultrasonography of the glenohumeral joints - a helpful instrument in differentiation in elderly onset rheumatoid arthritis and polymyalgia rheumatica

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