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

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Scand J Rheumatol. 2011 Jan;40(1):57-63. Epub 2010 Jul 24.

Ultrasonography in early assessment of elderly patients with

polymyalgic symptoms: a role in predicting diagnostic outcome?

Falsetti P, Acciai C, Volpe A, Lenzi L.

Department of Rehabilitation, San Donato Hospital, Arezzo, Italy.

Abstract

OBJECTIVE: To study the usefulness of ultrasonography (US) in

predicting the diagnostic outcome in patients with polymyalgic

symptoms.

METHODS: Sixty-one elderly patients with polymyalgic syndrome were

recruited in a secondary care setting and followed up in a prospective

way. Clinical, laboratory, and US data obtained at onset were

re-evaluated after 1 year when diagnostic outcome was defined.

RESULTS: A diagnostic shift was observed in 32 polymyalgic patients

(52%). Calcium pyrophosphate deposition disease (CPDD) was diagnosed

in nine patients, elderly-onset rheumatoid arthritis (EORA) in 18, and

elderly-onset spondyloarthritis (EOSpA) in five. In polymyalgia

rheumatica (PMR) patients US demonstrated synovitis in 90% of cases,

in both proximal (90%) and peripheral joints (41%). The best

predictive US model for the definitive diagnosis of PMR comprised: the

presence of subacromial-subdeltoid bursitis [odds ratio (OR) 5.603, p

= 0.003], low frequency of wrist (OR 0.074, p < 0.001),

metacarpophalangeal (OR 0.052, p < 0.001), and metatarsophalangeal

effusion/synovitis (OR 0.107, p < 0.027), low frequency of knee

menisci chondrocalcinosis (OR 0.091, p = 0.013), tendinous calcaneal

calcifications (OR 0.078, p = 0.006), and Achilles enthesitis (OR

0.107, p = 0.027), and low power Doppler US (PDUS) scores at wrist (OR

0.052, p < 0.001).

CONCLUSIONS: US and PDUS can be useful in distinguishing, at onset of

disease, pure PMR from other diseases mimicking this condition.

PMID: 20653466

http://www.ncbi.nlm.nih.gov/pubmed/20653466

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