Abstract
Owing to recent reports on its diagnostic utility, ultrasound (US) findings were added to EULAR/ACR 2012 provisional classification criteria for polymyalgia rheumatica (PMR). US findings of shoulder abnormalities (subacromial bursitis/bicipital tenosynovitis/glenohumeral effusion) or abnormalities in hip (hip effusion, trochanteric bursitis) are included in scoring algorithm, which improve the specificity of the clinical criteria significantly. However, in Japan, practical reports of US with PMR are limited. We report sequential ultrasonographic observation in three patients with PMR. Two of these patients, who were 81-year-old and 71-year-old male, presented with bilateral shoulder pain. One patient was 90-year-old female, who had unilateral headache. At baseline, all of them had US inflammation in bilateral shoulders, and elevation of erythrocyte sedimentation rate and C-reactive protein was seen. In female patient with headache, temporal artery US detected the finding of giant cell arteritis. Prednisolone was administered in all patients, and US follow-up was done after administration. US findings responded to corticosteroid therapy rapidly, as with their symptom and laboratory findings. Especially, in two of these patients, US inflammatory findings showed better sensitivity to change than laboratory markers of PMR activity. Asymptomatic bicipital tenosynovitis was observed in one patient during corticosteroid tapering. US appears to be useful for follow-up in addition to diagnosis with PMR.
