Semiquantitative Evaluation of Extrasynovial Soft Tissue Inflammation in the Shoulders of Patients with Polymyalgia Rheumatica and Elderly-Onset Rheumatoid Arthritis by Power Doppler Ultrasound

Abstract

Objectives. To develop a scoring system for evaluating the extrasynovial soft tissue inflammation of the shoulders in patients with polymyalgia rheumatica (PMR) and elderly-onset rheumatoid arthritis with PMR-like onset (pm-EORA) using ultrasound. Methods. We analyzed stored power Doppler (PD) images obtained by the pretreatment examination of 15 PMR patients and 15 pm-EORA patients. A semiquantitative scoring system for evaluating the severity of PD signals adjacent to the anterior aspect of the subscapularis tendon was designed. Results. A four-point scale scoring for the hyperemia on the subscapularis tendon was proposed as follows in brief: 0 = absent or minimal flow, 1 = single vessel dots or short linear-shape signals, 2 = long linear-shape signals or short zone-shape signals, or 3 = long zone-shape signals. This scoring system showed good intra- and interobserver reliability and good correlation to quantitative pixel-counting evaluation. By using it, we demonstrated that inflammation in PMR is dominantly localized in extrasynovial soft tissue as compared with pm-EORA. Conclusions. We proposed a reliable semiquantitative scoring system using ultrasound for the evaluation of extrasynovial soft tissue inflammation of the shoulders in patients with both PMR and pm-EORA. This system is simple to use and can be utilized in future investigations.

Perspectives and unmet needs in polymyalgia rheumatica. Providing the fundamental framework for the development of new treatment regimes in polymyalgia rheumatica

“…The scoring algorithm also requires a specific US pattern recognition, namely either the composite finding of pathology in one shoulder and one hip or in both shoulders. Nevertheless, the inclusion of US of hips and shoulders gained minor (48,49). Moreover, the increasing spatial resolution and emergence of functional imaging technologies also highlighted potential discriminating findings (50).…”

Predictors of glucocorticoid‐free remission in patients with polymyalgia rheumatica treated with prednisolone

“…Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease characterized by aching and morning stiffness in the shoulder, pelvic girdle, and neck in elderly individuals 1 . Although several sets of diagnostic criteria based on clinical manifestations and course are used, 2‐5 there is no diagnostic laboratory test or specific inflammatory marker to distinguish PMR from other inflammatory rheumatic diseases 3,6 …”

Proliferative Synovitis of the Shoulder Bursae is a Key Feature for Discriminating Elderly Onset Rheumatoid Arthritis Mimicking Polymyalgia Rheumatica From Polymyalgia Rheumatica

“…Table). 2 Ultrasonography was performed to evaluate persistent inflammatory pain and stiffness in the neck and shoulder girdle before starting treatment with corticosteroids or antirheumatic drugs. A final diagnosis was confirmed for all patients based on the 1-year follow-up clinical data.…”