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Inflammatory changes of hip synovial structures in polymyalgia rheumatica
F Cantini1, L Niccoli, C Nannini
1II Divisione di Medicina, Unità Reumatologica, Ospedale Misericordia e Dolce di Prato, Italy. fcantini@usl4.toscana.it
Clinical and Experimental Rheumatology
|August 13, 2005
Summary
Trochanteric bursitis is the most common hip lesion in polymyalgia rheumatica (PMR). Clinical examination is accurate for most hip lesions, but ultrasonography (US) is less sensitive than MRI for synovitis.
Area of Science:
- Rheumatology
- Medical Imaging
Background:
- Polymyalgia rheumatica (PMR) can present with pelvic girdle symptoms.
- Accurate diagnosis of hip inflammatory lesions is crucial for effective PMR management.
Purpose of the Study:
- To investigate hip inflammatory lesions in PMR patients.
- To compare the accuracy of clinical examination and ultrasonography (US) against magnetic resonance imaging (MRI) for diagnosing hip lesions in PMR.
- To evaluate the sensitivity and specificity of US versus MRI for hip lesions.
Main Methods:
- A case-control study involving 20 PMR patients and 40 controls.
- Clinical assessment for hip synovitis and bursitis (trochanteric, iliopsoas, ischiogluteal).
- Hip MRI and US were performed on PMR patients and a subset of controls.
Main Results:
- Trochanteric bursitis was detected in 100% of PMR patients by both MRI and US, significantly more than in controls.
- MRI detected hip synovitis in 85% of PMR patients, while US detected it in 45%.
- Clinical examination accurately identified hip synovitis, trochanteric, and ischiogluteal bursitis but overestimated iliopsoas bursitis. US showed lower sensitivity than MRI for synovitis and iliopsoas bursitis.
Conclusions:
- Trochanteric bursitis is the predominant hip inflammatory lesion in PMR.
- Clinical examination is valuable for detecting most hip inflammatory lesions in PMR, except for iliopsoas bursitis.
- Ultrasonography is less sensitive than MRI for assessing hip synovitis and iliopsoas bursitis in PMR.
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