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Magnetic resonance imaging of hand involvement in polymyalgia rheumatica: a comparison with seropositive rheumatoid

Martin Fruth1, Greta Kelmendi-Starova2, Philipp Martin-Seidel3

  • 1Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany martin.fruth@elisabethgruppe.de.

RMD Open
|May 7, 2026
PubMed
Abstract

Insights

Contrast-enhanced MRI (ceMRI) can differentiate hand involvement in polymyalgia rheumatica (PMR) from rheumatoid arthritis (RA+). PMR shows distinct periarticular inflammation patterns around metacarpophalangeal joints, aiding accurate diagnosis.

Area of Science:

  • Rheumatology
  • Medical Imaging
  • Diagnostic Techniques

Background:

  • Hand involvement is common in polymyalgia rheumatica (PMR), often leading to misdiagnosis as late-onset rheumatoid arthritis (RA).
  • Distinguishing between PMR and RA is crucial for appropriate treatment and patient management.

Purpose of the Study:

  • To compare the inflammatory patterns of hand involvement in PMR versus seropositive RA (RA+) using contrast-enhanced MRI (ceMRI).
  • To identify specific MRI features that can differentiate PMR from RA+ in the hands.

Main Methods:

  • Retrospective analysis of ceMRI scans from patients diagnosed with PMR and RA+ with suspected hand involvement.
  • Evaluation of synovitis, osteitis, and tenosynovitis in metacarpophalangeal (MCP) joints using the Rheumatoid Arthritis MRI Score.
  • Introduction of a semi-quantitative score for periarticular inflammation around MCP joints.

Main Results:

  • PMR cases exhibited predominantly minor to moderate synovitis and significantly higher periarticular inflammation scores compared to RA+.
  • Flexor tenosynovitis was more prevalent in PMR, while erosions and osteitis were absent in PMR but present in RA+.
  • A pattern of mild-to-moderate synovitis with severe periarticular inflammation in at least one MCP joint differentiated PMR from RA+ with 78.4% sensitivity and specificity.

Conclusions:

  • Contrast-enhanced MRI (ceMRI) effectively differentiates hand involvement in PMR from RA+.
  • The intensity of periarticular inflammation around MCP joints is a key distinguishing feature.
  • ceMRI findings can improve diagnostic accuracy and prevent misclassification of PMR as RA.
Keywords:
InflammationMagnetic Resonance ImagingPolymyalgia RheumaticaRheumatoid Arthritis

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