TY - JOUR
T1 - Baseline shoulder ultrasonography is not a predictive marker of response to glucocorticoids in patients with polymyalgia rheumatica: A 12-month followup study
AU - Miceli, Maria Concetta
AU - Zoli, Angelo
AU - Peluso, Giusy
AU - Bosello, Silvia Laura
AU - Gremese, Elisa
AU - Ferraccioli, Gianfranco
PY - 2017
Y1 - 2017
N2 - Objective. In this study, we evaluated whether ultrasound (US) subdeltoid bursitis (SB) and/or biceps tenosynovitis (BT) presence at baseline could represent a predictive marker of response to standard therapy after 12 months of followup, and whether a positive US examination could highlight the need of higher maintenance dosage of glucocorticoids (GC) at 6 and 12 months in patients with polymyalgia rheumatica (PMR). Methods. Sixty-six consecutive patients with PMR underwent bilateral shoulder US evaluations before starting therapy and after 12 months of followup. Absence of girdle pain and morning stiffness (clinical remission) and laboratory variables were evaluated. After diagnosis, all patients were treated with prednisone. Results. At baseline, SB and/or BT were present in 46 patients (70%), of whom 33 (72%) became negative while 13 (28%) remained positive at the 12-month US evaluation. All patients rapidly achieved a clinical remission, and at 6 months 26 (39%) also achieved a laboratory variable normalization. According to US positivity at baseline, no difference was found in remission or relapse rate after 12 months. Thirty patients (46%) at 6 months and 7 (11%) at 12 months were still taking more than 5 mg/day of prednisone. According to the US pattern at baseline, no difference was found in the mean GC dose at 6 and 12 months. Conclusion. In patients with PMR, the presence of SB and/or BT on US at diagnosis is not a predictive marker of GC response or of a higher GC dosage to maintain remission in a 12-month prospective followup study.
AB - Objective. In this study, we evaluated whether ultrasound (US) subdeltoid bursitis (SB) and/or biceps tenosynovitis (BT) presence at baseline could represent a predictive marker of response to standard therapy after 12 months of followup, and whether a positive US examination could highlight the need of higher maintenance dosage of glucocorticoids (GC) at 6 and 12 months in patients with polymyalgia rheumatica (PMR). Methods. Sixty-six consecutive patients with PMR underwent bilateral shoulder US evaluations before starting therapy and after 12 months of followup. Absence of girdle pain and morning stiffness (clinical remission) and laboratory variables were evaluated. After diagnosis, all patients were treated with prednisone. Results. At baseline, SB and/or BT were present in 46 patients (70%), of whom 33 (72%) became negative while 13 (28%) remained positive at the 12-month US evaluation. All patients rapidly achieved a clinical remission, and at 6 months 26 (39%) also achieved a laboratory variable normalization. According to US positivity at baseline, no difference was found in remission or relapse rate after 12 months. Thirty patients (46%) at 6 months and 7 (11%) at 12 months were still taking more than 5 mg/day of prednisone. According to the US pattern at baseline, no difference was found in the mean GC dose at 6 and 12 months. Conclusion. In patients with PMR, the presence of SB and/or BT on US at diagnosis is not a predictive marker of GC response or of a higher GC dosage to maintain remission in a 12-month prospective followup study.
KW - Immunology
KW - Immunology and Allergy
KW - Polymyalgia rheumatica biceps tendonitis
KW - Rheumatology
KW - Steroid dose
KW - Subdeltoid bursitis shoulder ultrasound
KW - Immunology
KW - Immunology and Allergy
KW - Polymyalgia rheumatica biceps tendonitis
KW - Rheumatology
KW - Steroid dose
KW - Subdeltoid bursitis shoulder ultrasound
UR - http://hdl.handle.net/10807/102197
UR - http://www.jrheum.org/content/jrheum/44/2/241.full.pdf
U2 - 10.3899/jrheum.160090
DO - 10.3899/jrheum.160090
M3 - Article
SN - 0315-162X
VL - 44
SP - 241
EP - 247
JO - THE JOURNAL OF RHEUMATOLOGY
JF - THE JOURNAL OF RHEUMATOLOGY
ER -