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Imaging methods in polymyalgia rheumatica: a systematic review

  • Systematic Review
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Abstract

Polymyalgia rheumatica (PMR) is an inflammatory joint disease in patients over 50 years of age with pain and prolonged morning stiffness in the shoulder and hip girdles and neck. The lack of specific clinical findings, laboratory signs, biomarker and established imaging methods makes it difficult to diagnose patients with this disease. The aim of the systematic review is to present the literature data on the use of imaging methods for early diagnosis, assessment of disease activity and therapeutic response in PMR. At the same time, the advantages, disadvantages and contraindications of each method are considered. A literature search was carried out in PubMed and Scopus up to June 2022. Studies were selected that met the following criteria: (1) English language publications in peer-reviewed journals, (2) cohort or case–control studies and a series of more than five clinical cases, (3) studies of newly diagnosed or suspected PMR patients according to classification criteria or expert opinion, (4) imaging evaluation of articular, extraarticular and vascular impairment in PMR. Out of a total of 1431 publications, 61 articles were selected, which differed in the imaging techniques used: radiography (5), scintigraphy (4), magnetic resonance imaging (14), PET/CT (14) and ultrasound (24). Prevalence of extraarticular involvement (tendons, entheses and bursae) was identified in patients with PMR. In a significant number of cases, subclinical vasculitis of the large vessels was found, confirming the common pathogenetic pathways of the two diseases. The diagnostic, therapeutic and prognostic potential of imaging methods in PMR has been relatively poorly studied and remains to be clarified.

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The data sets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Propedeutics of Internal Diseases, Medical University—Plovdiv, Plovdiv, Bulgaria

    L. Mekenyan, R. Karalilova, P. Todorov, N. Tepeliev & A. Batalov

  2. Rheumatology Clinic, University Hospital “Kaspela”—Plovdiv, Plovdiv, Bulgaria

    L. Mekenyan, R. Karalilova, P. Todorov, N. Tepeliev & A. Batalov

  3. Clinic of Rheumatology, Medical University of Plovdiv, University Hospital “Kaspela”, 64 Sofia Str., 4001, Plovdiv, Bulgaria

    L. Mekenyan

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  1. L. Mekenyan
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  4. N. Tepeliev
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Contributions

RK and AB wrote the review protocol including search strategies and clinical perspective. LM and RK screened papers for inclusion and appraised quality. Data extraction and analysis were performed by LM. The draft of the manuscript was written by LM and critically revised for important intellectual content by the other authors RK, PT, NT, AB. All authors, LM, RK, PT, NT, AB contributed to the design and/or interpretation and approved the final version. Accountability for all aspects of the work is agreed to be shared among all authors. All co-authors take full responsibility for the integrity and accuracy of all aspects of the work.

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Correspondence to L. Mekenyan.

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All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Prof. Anastas Batalov has received consulting fees from Abbvie, Roche, Sandoz, MSD, Novartis, Pfizer, UCB, Boehringer Ingelheim, Eli Lilly, Stada, Janssen. The other authors have no conflict of interest to declare.

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Mekenyan, L., Karalilova, R., Todorov, P. et al. Imaging methods in polymyalgia rheumatica: a systematic review. Rheumatol Int 43, 825–840 (2023). https://doi.org/10.1007/s00296-023-05284-8

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