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

Abstract

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.

Ultrasonography in early assessment of elderly patients with polymyalgic symptoms: a role in predicting diagnostic outcome?

“…Ultrasonography (US) has been proved to increase diagnostic effectiveness in musculoskeletal conditions and to significantly influence the management of rheumatic patients. US has already been effectively used in diagnosing PMR (8)(9)(10)(11)(12)(13).…”

Current understanding and management of giant cell arteritis and polymyalgia rheumatica

“…Typical findings on ultrasound include subdeltoid bursitis and bicep tendon tenosynovitis at the shoulders [76,77] and, less frequently, synovitis of the glenohumoral joint. In the hips, ultrasound often reveals synovitis and trochanteric bursitis [78][79][80]. It has been suggested that ultrasound may facilitate the proper diagnosis in patients with the typical proximal symptoms of PMR who also have normal ESR [81].…”

Place de l’échographie ostéo-articulaire dans la prise en charge de la pseudopolyarthrite rhizomélique

“…La différence nosologique reposait sur l'évolution ou d'autres signes typiques. Il était trouvé une atteinte inflammatoire globale de l'épaule chez 40,9 % des PPR contre 65,5 % des PR [13]. Cette même équipe avait réalisé, deux ans auparavant, un travail similaire comparant 13 PPR à 19 PR précoces, les taux d'atteinte inflammatoire de l'épaule étant similaires dans les deux études ; on peut toutefois émettre quelques réserves quant au diagnostic de PR séro-négative chez des sujets de plus de 60 ans qui, malgré les lésions associées décrites comme typiques, étaient peut-être des PPR [14].…”