Place de l’échographie ostéo-articulaire dans la prise en charge de la pseudopolyarthrite rhizomélique

Abstract

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatism in the elderly. It is characterized by inflammatory pain of scapular and pelvic area. In the absence of biological signature, these symptoms may be non-specific and therefore discuss other diagnoses in the elderly. In this context, ultrasound has been developed, in order to assist in the diagnosis and monitoring of treatment. Thus, since 2012, the new classification criteria EULAR 2012 include ultrasonography. In particular, the following abnormalities will be searched: at least one shoulder (subdeltoid bursitis, biceps tenosynovitis or glenohumeral synovitis), and at least one hip (hip joint synovitis or trochanteric bursitis) ; or bilateral involvement of the shoulders. These abnormalities are not specific of PMR, but their presence will have more value if the clinical and biological context is suggestive, especially in case of bilateral abnormalities. This is an easily, non-invasive and accessible examination. Its intra- and inter-observer reproducibility seems excellent. Moreover, its quite good sensitivity to change could make it a useful tool for the monitoring of treatment.