title: Evidence for synovitis in active polymyalgia rheumatica: sonographic study in a large series of patients.
abstract: OBJECTIVE
  To determine the frequency and localization of synovitis and enthesitis in patients with active, untreated polymyalgia rheumatica (PMR) by ultrasonography (US).
  
  
  METHODS
  Polyarticular sonographic evaluation was carried out in 50 consecutive patients with PMR at disease onset. Results were compared with 50 consecutive patients with seronegative spondyloarthropathies (SpA) and 50 with seronegative and seropositive rheumatoid arthritis (RA) at disease onset.
  
  
  RESULTS
  Synovitis and/or effusion was detected, in at least one joint, in 100% of patients with PMR. The most frequent alterations observed in patients with PMR were effusion in the subacromial-subdeltoid (SA-SD) bursa in 70% of patients, tenosynovitis of the long head of the biceps tendon (LHBT) in 68%, glenohumeral joint effusion in 66%, tenosynovitis of the flexor tendons in the carpal tunnel in 38%, radiocarpal effusion in 18%, wrist extensors tenosynovitis in 18%, coxofemoral joint effusion in 40%. knee effusion in 38%, and ankle effusion in 10%. Enthesitis and tendonitis of the anchoring tendons were relatively rare in all the articular sites. Comparison of the SpA and PMR patients showed that enthesitis (mostly in the elbow, knee, and heel) was significantly more frequent in SpA. There was a significant difference in glenohumeral and coxofemoral effusion between the PMR and SpA patients (66% vs 16% and 40% vs 14%, respectively). Comparison of PMR and RA patients showed no significant difference in the involvement of entheses, shoulder, hip, or wrist flexor tendons in the carpal tunnel. Synovitis of the elbow, knee, and wrist was significantly more frequent in the SpA and RA patients than in those with PMR.
  
  
  CONCLUSIONS
  Synovitis was detected in at least one site in 100% of patients with PMR. SA-SD bursitis, LHBT tenosynovitis, carpal tunnel syndrome, and glenohumeral, knee and hip synovitis were the most frequent alterations in PMR. Enthesitis was relatively rare at any articular site.
authors.affiliation: Institute of Rheumatology, University of Siena, Policlinico Le Scotte, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Frediani
authors.forename: Paolo
authors.initials: P
authors.lastname: Falsetti
authors.forename: Lara
authors.initials: L
authors.lastname: Storri
authors.forename: Stefania
authors.initials: S
authors.lastname: Bisogno
authors.forename: Fabio
authors.initials: F
authors.lastname: Baldi
authors.forename: Valeria
authors.initials: V
authors.lastname: Campanella
authors.forename: Caterina
authors.initials: C
authors.lastname: Acciai
authors.forename: Georgios
authors.initials: G
authors.lastname: Filippou
authors.forename: Francesca
authors.initials: F
authors.lastname: Chellini
authors.forename: Roberto
authors.initials: R
authors.lastname: Cosentino
authors.forename: Roberto
authors.initials: R
authors.lastname: Marcolongo
mesh_terms: D000367:Age Factors; D000368:Aged; D001168:Arthritis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D012737:Sex Factors; D013583:Synovial Membrane / Q000473:pathology* / Q000503:physiopathology / Q000648:ultrastructure*; D013585:Synovitis / Q000473:pathology* / Q000503:physiopathology; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D013710:Tendons / Q000473:pathology / Q000503:physiopathology / Q000648:ultrastructure*; D013717:Tenosynovitis / Q000473:pathology* / Q000503:physiopathology; D014463:Ultrasonography