Whole-body MRI of patients with polymyalgia rheumatica identifies a distinct subset with complete patient-reported response to glucocorticoids

Sarah Louise Mackie, Colin Thomas Pease, Eiji Fukuba, Emma Harris, Paul Emery, Richard Hodgson, Jane Freeston, Dennis McGonagle

Research output: Contribution to journalArticle

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Abstract

Objectives: To determine whether whole-body MRI defines clinically relevant subgroups within polymyalgia rheumatica (PMR) including glucocorticoid responsiveness. Methods: 22 patients with PMR and 16 with rheumatoid arthritis (RA), untreated and diagnosed by consultant rheumatologists, underwent whole-body, multiple-joint MRI, scored by two experts. Patients with PMR reported whether they felt 'back to normal' on glucocorticoid therapy and were followed for a median of 2 years. Results: All patients with PMR were deemed to respond to glucocorticoids clinically. A characteristic pattern of symmetrical, extracapsular inflammation, adjacent to greater trochanter, acetabulum, ischial tuberosity and/or symphysis pubis, was observed in 14/22 of the PMR cases. In PMR, this pattern was associated with complete glucocorticoid response (p=0.01), higher pretreatment Creactive protein (CRP) and serum interleukin-6 (IL-6), and better post-treatment fatigue and function. Only 1/14 in the extracapsular group could stop glucocorticoids within 1 year, compared with 4/7 of the others. A score derived from the five sites discriminating best between PMR and RA correlated with IL-6 (p<0.002). IL-6 levels ≥16.8 pg/mL had 86% sensitivity and 86% specificity for the extracapsular MRI pattern. Conclusions: A subset of patients with rheumatologist diagnosed PMR had a characteristic, extracapsular pattern of MRI inflammation, associated with elevated IL-6/CRP and with complete patient-reported glucocorticoid responsiveness.

Original languageEnglish
Pages (from-to)2188-2192
Number of pages5
JournalAnnals of the Rheumatic Diseases
Volume74
Issue number12
Early online date10 Nov 2015
DOIs
Publication statusPublished - 1 Dec 2015
Externally publishedYes

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Polymyalgia Rheumatica
Magnetic resonance imaging
Glucocorticoids
Interleukin-6
Rheumatoid Arthritis
Pubic Bone
Inflammation
Acetabulum
Blood Proteins
Consultants
Fatigue of materials
Femur
Fatigue
Joints
Sensitivity and Specificity

Cite this

Mackie, Sarah Louise ; Pease, Colin Thomas ; Fukuba, Eiji ; Harris, Emma ; Emery, Paul ; Hodgson, Richard ; Freeston, Jane ; McGonagle, Dennis. / Whole-body MRI of patients with polymyalgia rheumatica identifies a distinct subset with complete patient-reported response to glucocorticoids. In: Annals of the Rheumatic Diseases. 2015 ; Vol. 74, No. 12. pp. 2188-2192.
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abstract = "Objectives: To determine whether whole-body MRI defines clinically relevant subgroups within polymyalgia rheumatica (PMR) including glucocorticoid responsiveness. Methods: 22 patients with PMR and 16 with rheumatoid arthritis (RA), untreated and diagnosed by consultant rheumatologists, underwent whole-body, multiple-joint MRI, scored by two experts. Patients with PMR reported whether they felt 'back to normal' on glucocorticoid therapy and were followed for a median of 2 years. Results: All patients with PMR were deemed to respond to glucocorticoids clinically. A characteristic pattern of symmetrical, extracapsular inflammation, adjacent to greater trochanter, acetabulum, ischial tuberosity and/or symphysis pubis, was observed in 14/22 of the PMR cases. In PMR, this pattern was associated with complete glucocorticoid response (p=0.01), higher pretreatment Creactive protein (CRP) and serum interleukin-6 (IL-6), and better post-treatment fatigue and function. Only 1/14 in the extracapsular group could stop glucocorticoids within 1 year, compared with 4/7 of the others. A score derived from the five sites discriminating best between PMR and RA correlated with IL-6 (p<0.002). IL-6 levels ≥16.8 pg/mL had 86{\%} sensitivity and 86{\%} specificity for the extracapsular MRI pattern. Conclusions: A subset of patients with rheumatologist diagnosed PMR had a characteristic, extracapsular pattern of MRI inflammation, associated with elevated IL-6/CRP and with complete patient-reported glucocorticoid responsiveness.",
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Whole-body MRI of patients with polymyalgia rheumatica identifies a distinct subset with complete patient-reported response to glucocorticoids. / Mackie, Sarah Louise; Pease, Colin Thomas; Fukuba, Eiji; Harris, Emma; Emery, Paul; Hodgson, Richard; Freeston, Jane; McGonagle, Dennis.

In: Annals of the Rheumatic Diseases, Vol. 74, No. 12, 01.12.2015, p. 2188-2192.

Research output: Contribution to journalArticle

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AU - Mackie, Sarah Louise

AU - Pease, Colin Thomas

AU - Fukuba, Eiji

AU - Harris, Emma

AU - Emery, Paul

AU - Hodgson, Richard

AU - Freeston, Jane

AU - McGonagle, Dennis

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N2 - Objectives: To determine whether whole-body MRI defines clinically relevant subgroups within polymyalgia rheumatica (PMR) including glucocorticoid responsiveness. Methods: 22 patients with PMR and 16 with rheumatoid arthritis (RA), untreated and diagnosed by consultant rheumatologists, underwent whole-body, multiple-joint MRI, scored by two experts. Patients with PMR reported whether they felt 'back to normal' on glucocorticoid therapy and were followed for a median of 2 years. Results: All patients with PMR were deemed to respond to glucocorticoids clinically. A characteristic pattern of symmetrical, extracapsular inflammation, adjacent to greater trochanter, acetabulum, ischial tuberosity and/or symphysis pubis, was observed in 14/22 of the PMR cases. In PMR, this pattern was associated with complete glucocorticoid response (p=0.01), higher pretreatment Creactive protein (CRP) and serum interleukin-6 (IL-6), and better post-treatment fatigue and function. Only 1/14 in the extracapsular group could stop glucocorticoids within 1 year, compared with 4/7 of the others. A score derived from the five sites discriminating best between PMR and RA correlated with IL-6 (p<0.002). IL-6 levels ≥16.8 pg/mL had 86% sensitivity and 86% specificity for the extracapsular MRI pattern. Conclusions: A subset of patients with rheumatologist diagnosed PMR had a characteristic, extracapsular pattern of MRI inflammation, associated with elevated IL-6/CRP and with complete patient-reported glucocorticoid responsiveness.

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