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Accuracy of Musculoskeletal Imaging for the Diagnosis of Polymyalgia Rheumatica: Systematic Review

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Accuracy of Musculoskeletal Imaging for the Diagnosis of Polymyalgia Rheumatica: Systematic Review

Sarah Louise Mackie et al. RMD Open.

Abstract

Objectives: To review the evidence for accuracy of imaging for diagnosis of polymyalgia rheumatica (PMR).

Methods: Searches included MEDLINE, EMBASE and PubMed. Evaluations of diagnostic accuracy of imaging tests for PMR were eligible, excluding reports with <10 PMR cases. Two authors independently extracted study data and three authors assessed methodological quality using modified QUADAS-2 criteria.

Results: 26 studies of 2370 patients were evaluated: 10 ultrasound scanning studies; 6 MRI studies; 1 USS and MRI study; 7 18-fluorodeoxyglucose-positron emission tomography (PET) studies; 1 plain radiography and 1 technetium scintigraphy study. In four ultrasound studies, subacromial-subdeltoid bursitis had sensitivity 80% (95% CI 55% to 93%) and specificity 68% (95% CI 60% to 75%), whereas bilateral subacromial-subdeltoid bursitis had sensitivity 66% (95% CI 43% to 87%) and specificity 89% (95% CI 66% to 97%). Sensitivity for ultrasound detection of trochanteric bursitis ranged from 21% to 100%. In four ultrasound studies reporting both subacromial-subdeltoid bursitis and glenohumeral synovitis, detection of subacromial-subdeltoid bursitis was more accurate than that of glenohumeral synovitis (p=0.004). MRI and PET/CT revealed additional areas of inflammation in the spine and pelvis, including focal areas between the vertebrae and anterior to the hip joint, but the number of controls with inflammatory disease was inadequate for precise specificity estimates.

Conclusions: Subacromial-subdeltoid bursitis appears to be the most helpful ultrasound feature for PMR diagnosis, but interpretation is limited by study heterogeneity and methodological issues, including variability in blinding and potential bias due to case-control study designs. Recent MRI and PET/CT case-control studies, with blinded readers, yielded promising data requiring validation within a diagnostic cohort study.

Keywords: Magnetic Resonance Imaging; Polymyalgia Rheumatica; Ultrasonography.

Figures

Figure 1
Figure 1
Flow chart for systematic review.
Figure 2
Figure 2
Summary ROC plot for bilateral subacromial bursitis. ROC, receiver operating characteristic.

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References

    1. Crowson CS, Matteson EL, Myasoedova E et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum 2011;63:633–9. 10.1002/art.30155 - DOI - PMC - PubMed
    1. Lawrence RC, Felson DT, Helmick CG et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008;58:26–35. 10.1002/art.23176 - DOI - PMC - PubMed
    1. Mackie SL, Mallen CD. Polymyalgia rheumatica. BMJ 2013;347:f6937 10.1136/bmj.f6937 - DOI - PubMed
    1. Hutchings A, Hollywood J, Lamping DL et al. Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica. Arthritis Rheum 2007;57:803–9. 10.1002/art.22777 - DOI - PubMed
    1. Mazzantini M, Torre C, Miccoli M et al. Adverse events during longterm low-dose glucocorticoid treatment of polymyalgia rheumatica: a retrospective study. J Rheumatol 2012;39:552–7. 10.3899/jrheum.110851 - DOI - PubMed
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