Ultrasound imaging for the rheumatologist XLIII. Ultrasonographic evaluation of shoulders and hips in patients with polymyalgia rheumatica: a systematic literature review.
OBJECTIVE
Musculoskeletal ultrasonography (US) has lately been applied to patients with polymyalgia rheumatica for the examination of shoulders and hip, and included in the 2012 PMR classification criteria. We aimed to perform a comprehensive overview of the literature on this topic with a systematic review.


METHODS
We searched PubMed, Embase, the Cochrane library and the proceedings from EULAR and ACR congresses (2011-2012). We included studies evaluating patients with confirmed or suspected PMR, undergoing US of shoulders and/or hips. The diagnosis of PMR could be based on expert opinion or diagnostic criteria. Cohort, case-control, diagnostic accuracy studies and case-series were eligible for inclusion. The features of the included studies were presented. When available, sensitivities and specificities were calculated for primary studies.


RESULTS
Out of 1736 papers identified by our search, 13 articles and 1 abstract were finally included in the review. Eight studies focused on shoulder US, 1 on hip US, 4 on both. Studies were extremely variable in terms of population, US examination, reference standard and control population. In general, at the shoulder, pathological bilateral US findings in most studies were more prevalent in patients with PMR compared to controls. When sensitivity and specificity could be calculated, bilateral findings were more sensitive. Notably, less information was available on hip US.


CONCLUSIONS
US (especially in shoulder examination) is confirmed to be a potentially useful instrument to integrate clinical information in the management of patients with PMR. Its additional value in conjunction with the new classification criteria should be further tested.
IRCCS Policlinico San Matteo Foundation, Pavia, Italy. filiciasak@gmail.com
Garifallia
G
Sakellariou
Annamaria
A
Iagnocco
Lucrezia
L
Riente
Fulvia
F
Ceccarelli
Linda
L
Carli
Luca
L
Di Geso
Andrea
A
Delle Sedie
Emilio
E
Filippucci
Carlomaurizio
C
Montecucco
D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging*; D011111:Polymyalgia Rheumatica / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012785:Shoulder Joint / Q000000981:diagnostic imaging*; D013710:Tendons / Q000000981:diagnostic imaging*; D014463:Ultrasonography