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Shoulder ultrasound and serum lactate dehydrogenase predict inadequate response to glucocorticoid treatment in patients with polymyalgia rheumatica

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Abstract

We aimed to identify predictors of inadequate response to glucocorticoid (GC) treatment in patients with polymyalgia rheumatica (PMR). We retrospectively studied 32 patients as a derivation cohort and 24 patients as a validation cohort. The patients were divided into two groups according to the response to GC treatment: GC-responders and GC-inadequate responders (GC-IRs). We compared laboratory data and bilateral shoulder ultrasound findings between the groups. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff value of candidate predictors of treatment response; the predictors were examined using multivariate logistic analysis. Gray-scale ultrasound findings of long head of the biceps (LHB) tenosynovitis and subacromial/subdeltoid (SAD) bursitis were scored semiquantitatively (0–3). A total gray-scale score (TGSS) was calculated as the sum of the gray-scale scores. In the derivation cohort, serum lactate dehydrogenase (LDH) levels and TGSS were significantly higher in GC-IRs than in GC-responders. On ROC analysis, the cutoff values of serum LDH levels ≥ 175 IU/ml and TGSS ≥ 5 were found to be the candidate predictors. Multivariate logistic analysis revealed an independent association of both the predictors with inadequate response to GC treatment. In the validation cohort, patients with one or both predictors exhibited a higher incidence of inadequate response to GC treatment. These findings indicate that the severities of LHB tenosynovitis and SAD bursitis evaluated using ultrasound and serum LDH levels are independent predictors of inadequate response to GC treatment in patients with PMR. Treatment adjustment based on prediction model may allow precise treatment of patients with PMR.

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Funding

This work was supported by Japan Society for the Promotion of Science (grant number JSPS KAKENHI 16K19603).

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Author notes

  1. Kenta Misaki

    Present address: Department of Rheumatology, Kita-harima Medical Center, Ono, Japan

Authors and Affiliations

  1. Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Masahiro Ayano, Yojiro Arinobu, Hiroshi Tsukamoto, Hiroki Mitoma, Mitsuteru Akahoshi & Koichi Akashi

  2. Department of Cancer Stem Cell Research, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan

    Masahiro Ayano

  3. Department of Rheumatology, Shimonoseki City Hospital, Shimonoseki, Japan

    Shun-ichiro Ota

  4. Department of Endocrinology and Rheumatology, Kurashiki Central Hospital, Kurashiki, Japan

    Kenta Misaki & Keisuke Nishimura

  5. Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Japan

    Yasutaka Kimoto & Takahiko Horiuchi

  6. Department of Medical Education, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan

    Hiroaki Niiro

  7. Department of Rheumatology, Shin-Kokura Hospital, Kitakyushu, Japan

    Hiroshi Tsukamoto

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  1. Masahiro Ayano
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Contributions

MAy and YA participated in study conception and design. MAy, SO, KM, and KN participated in data acquisition and analysis. MAy, YA, HT, YK, HM, MAk, KA, TH, and HN contributed to the interpretation of results. MAy was a major contributor in writing the manuscript. All authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Masahiro Ayano.

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Conflict of interest

Masahiro Ayano, Yojiro Arinobu, Hiroshi Tsukamoto, Shun-ichiro Ota, Kenta Misaki, Keisuke Nishimura, Yasutaka Kimoto, Hiroki Mitoma, Mitsuteru Akahoshi, Koichi Akashi, Takahiko Horiuchi, and Hiroaki Niiro declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee of the Kyushu University Hospital (approval number 2019-061), and the principles of the Helsinki Declaration were followed throughout the study. Because this was retrospective research, we disclosed the study information at the site of the related facilities. Obtaining patient consent was not required according to the committee’s procedures.

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Ayano, M., Arinobu, Y., Tsukamoto, H. et al. Shoulder ultrasound and serum lactate dehydrogenase predict inadequate response to glucocorticoid treatment in patients with polymyalgia rheumatica. Rheumatol Int 40, 1101–1109 (2020). https://doi.org/10.1007/s00296-020-04512-9

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