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Lumbar interspinous bursitis in active polymyalgia rheumatica.

Carlo Salvarani1, Libero Barozzi, Luigi Boiardi

  • 1Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy. salvarani.carlo@asmn.re.it

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Area of Science:

  • Rheumatology
  • Musculoskeletal Imaging
  • Inflammatory Diseases

Background:

  • Polymyalgia rheumatica (PMR) is an inflammatory condition typically affecting proximal muscles.
  • Low back pain is a common symptom in PMR patients, but its cause is not fully understood.
  • Lumbar interspinous bursae are anatomical structures that can become inflamed.

Purpose of the Study:

  • To investigate the presence and extent of inflammation in lumbar interspinous bursae in patients diagnosed with PMR.
  • To determine if inflammation of these bursae is associated with low back pain in PMR.
  • To utilize magnetic resonance imaging (MRI) as the primary diagnostic tool for evaluating bursal inflammation.

Main Methods:

  • A cohort of 10 new, untreated PMR patients with shoulder and pelvic girdle pain were recruited.
  • Control groups included patients with spondyloarthritis, spinal osteoarthritis, and rheumatoid arthritis presenting with lumbar pain.
  • All participants underwent lumbar spine MRI; a subset also had thoracic spine MRI.

Main Results:

  • Lumbar interspinous bursitis was detected by MRI in 90% of PMR patients and 45% of controls.
  • Moderate to marked lumbar bursitis (grade ≥2) was significantly more prevalent in PMR patients (60%) compared to controls (9%, p=0.020).
  • The L3-L5 interspaces were the most common sites for lumbar bursitis in both groups; no thoracic interspinous bursitis was observed.

Conclusions:

  • Inflammation of lumbar interspinous bursae is a frequent finding in PMR and may be a significant contributor to low back pain.
  • The study supports the hypothesis that PMR involves inflammation of extra-articular synovial structures, including those in the lumbar spine.
  • MRI is a valuable tool for identifying bursal inflammation in the context of PMR diagnosis and symptom evaluation.