Usefulness of ultrasound as a predictor of elderly-onset rheumatoid arthritis with polymyalgia rheumatica-like onset

Abstract

Objectives Differentiation between polymyalgia rheumatica (PMR) and elderly onset rheumatoid arthritis (EORA), especially in elderly patients, is often difficult due to similarities in symptoms and serological kinetics. In this study, we aimed to analyze the predictors of EORA with PMR-like onset. Methods Seventy-two patients diagnosed with PMR, who attended our hospital for routine care and underwent musculoskeletal ultrasonography (MSUS) at that time were evaluated. Synovitis was evaluated semi-quantitatively (0-3) by gray scale (GS) and power doppler (PD) in 24 joints (both hands [wrist, metacarpophalageal, and proximal interphalangeal joints] and both shoulder joints). Results Overall, 18 patients had RA (25.0%); the mean age was 75.0 years, and 34.7% and 65.3% were male and female, respectively. In PMR and PMR/EORA groups, multivariate logistic analysis showed that rheumatoid factor (RF) positivity, GS ≥2 of hand joints, and PD ≥1 of hand joints were independent factors with significant differences. At least 1 of the 3 factors had a sensitivity of 88.9% and specificity of 92.6%. Conclusions Presence of at least one of the criteria: RF positivity, GS ≥ 2, and PD ≥ 1 of hand joints, suggested the possibility of developing EORA within 1 year of PMR diagnosis.

Polymyalgia rheumatica - an up-to-date review on diagnosis and management

“…They demonstrated significantly higher grey scale and power Doppler US grades of both subacromial and subdeltoid bursitis in those with LORA vs. those with PMR [76] . The authors postulate that the differing degrees of synovial proliferation are the key pathological difference driving the contrasting US changes, with the synovitis in PMR being primarily exudative in nature vs. the predominantly proliferative synovitis observed in rheumatoid arthritis [76] . A recent retrospective study demonstrated the prognostic value of bilateral hand US in discriminating PMR from LORA, with the presence of at least one of the following increasing the probability of a diagnosis of LORA within 1 year from PMR diagnosis: rheumatoid factor positivity, grey scale synovitis in 2 of hand joints, and power Doppler positivity in 1 hand joints [77] .…”

“…LORA is one of the most common mimics of PMR, and perhaps the most difficult to differentiate clinically from PMR. One study compared the semiquantitative scoring of both grey scale and power Doppler US changes in the subacromial and subdeltoid bursae of those with PMR to those with LORA [76] . They demonstrated significantly higher grey scale and power Doppler US grades of both subacromial and subdeltoid bursitis in those with LORA vs. those with PMR [76] .…”

“…One study compared the semiquantitative scoring of both grey scale and power Doppler US changes in the subacromial and subdeltoid bursae of those with PMR to those with LORA [76] . They demonstrated significantly higher grey scale and power Doppler US grades of both subacromial and subdeltoid bursitis in those with LORA vs. those with PMR [76] . The authors postulate that the differing degrees of synovial proliferation are the key pathological difference driving the contrasting US changes, with the synovitis in PMR being primarily exudative in nature vs. the predominantly proliferative synovitis observed in rheumatoid arthritis [76] .…”

Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options

“…In this context, the presence of anti-CCP positivity in EORA and bilateral subacromial bursitis in PMR can be diagnostic aids. A recent study by Nawata et al [40] analyzed predictors of EORA with a PMR-like onset in patients initially diagnosed with PMR in 72 patients. During follow-up, 25% of these patients were subsequently diagnosed with RA.…”