title: Baseline Shoulder Ultrasonography Is Not a Predictive Marker of Response to Glucocorticoids in Patients with Polymyalgia Rheumatica: A 12-month Followup Study.
abstract: In this study, we evaluated whether ultrasound (US) subdeltoid bursitis (SB) and/or biceps tenosynovitis (BT) presence at baseline could represent a predictive marker of response to standard therapy after 12 months of followup, and whether a positive US examination could highlight the need of higher maintenance dosage of glucocorticoids (GC) at 6 and 12 months in patients with polymyalgia rheumatica (PMR).
  
  
  
  Sixty-six consecutive patients with PMR underwent bilateral shoulder US evaluations before starting therapy and after 12 months of followup. Absence of girdle pain and morning stiffness (clinical remission) and laboratory variables were evaluated. After diagnosis, all patients were treated with prednisone.
  
  
  
  At baseline, SB and/or BT were present in 46 patients (70%), of whom 33 (72%) became negative while 13 (28%) remained positive at the 12-month US evaluation. All patients rapidly achieved a clinical remission, and at 6 months 26 (39%) also achieved a laboratory variable normalization. According to US positivity at baseline, no difference was found in remission or relapse rate after 12 months. Thirty patients (46%) at 6 months and 7 (11%) at 12 months were still taking more than 5 mg/day of prednisone. According to the US pattern at baseline, no difference was found in the mean GC dose at 6 and 12 months.
  
  
  
  In patients with PMR, the presence of SB and/or BT on US at diagnosis is not a predictive marker of GC response or of a higher GC dosage to maintain remission in a 12-month prospective followup study.
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.|M.C. Miceli, MD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; A. Zoli, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Peluso, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; S. Bosello, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; E. Gremese, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Ferraccioli, MD, Professor of Rheumatology, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Miceli
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.|M.C. Miceli, MD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; A. Zoli, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Peluso, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; S. Bosello, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; E. Gremese, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Ferraccioli, MD, Professor of Rheumatology, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart.
authors.forename: Angelo
authors.initials: A
authors.lastname: Zoli
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.|M.C. Miceli, MD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; A. Zoli, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Peluso, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; S. Bosello, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; E. Gremese, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Ferraccioli, MD, Professor of Rheumatology, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart.
authors.forename: Giusy
authors.initials: G
authors.lastname: Peluso
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.|M.C. Miceli, MD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; A. Zoli, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Peluso, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; S. Bosello, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; E. Gremese, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Ferraccioli, MD, Professor of Rheumatology, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bosello
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.|M.C. Miceli, MD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; A. Zoli, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Peluso, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; S. Bosello, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; E. Gremese, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Ferraccioli, MD, Professor of Rheumatology, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart.
authors.forename: Elisa
authors.initials: E
authors.lastname: Gremese
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy. gf.ferraccioli@rm.unicatt.it.|M.C. Miceli, MD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; A. Zoli, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Peluso, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; S. Bosello, MD, PhD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; E. Gremese, MD, Associate Professor, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart; G. Ferraccioli, MD, Professor of Rheumatology, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart. gf.ferraccioli@rm.unicatt.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011237:Predictive Value of Tests; D012782:Shoulder / Q000000981:diagnostic imaging*; D012785:Shoulder Joint / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D005938:Glucocorticoids
keywords: BICEPS TENDONITIS; POLYMYALGIA RHEUMATICA; SHOULDER ULTRASOUND; STEROID DOSE; SUBDELTOID BURSITIS