Ultrasonography and magnetic resonance imaging changes in patients with polymyalgia rheumatica treated by tocilizumab

Anaïs Huwart,Alain Saraux,Sandrine Jousse-Joulin,Thierry Marhadour,Florent Garrigues,Maelenn Gouillou,Valérie Devauchelle-Pensec,Dewi Guellec,Divi Cornec

doi:10.1186/s13075-017-1499-2

Anaïs Huwart, Alain Saraux + Show 7 more

Open Access

https://doi.org/10.1186/s13075-017-1499-2

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Abstract

BackgroundThis study assessed inflammatory changes using ultrasound (US) and magnetic resonance imaging (MRI) in patients taking tocilizumab for polymyalgia rheumatica (PMR).MethodsEighteen patients were included in the prospective open-label TENOR study and received three tocilizumab infusions, without corticosteroids. B-mode and power Doppler US and MRI (T1 and T2-short time inversion recuperation weighted sequences) of the hips and shoulders were performed at weeks 0, 2, and 12. Subacromial, trochanteric, and iliopsoas bursitis and intraarticular glenohumeral and coxofemoral effusions/synovitis were scored from 0 to 3. Changes over time and US–MRI correlations were evaluated.ResultsAt baseline, the proportions of shoulders and hips with bursitis were 93 and 100% by MRI and 61 and 13% by US; and the corresponding proportions for intraarticular effusions/synovitis were 100 and 100% by MRI and 57 and 53% by US. Imaging findings did not improve during the first two treatment weeks. From baseline to week 12, bursitis improved significantly at all four joints by MRI (P = 0.005) and US (P = 0.029) and intraarticular effusions/synovitis by US only (P = 0.001). The proportion of abnormalities that improved by week 12 was 42% by MRI and 37% by US. MRI detected bursitis in a larger proportion of hips (73% versus 13%) and US in a larger proportion of shoulders (57% versus 28%), whereas no difference was found for intraarticular effusions/synovitis. At baseline, agreement between US and MRI findings was poor.ConclusionsUS and MRI showed significant improvements in inflammatory lesions during tocilizumab treatment of PMR.

Highlights

This study assessed inflammatory changes using ultrasound (US) and magnetic resonance imaging (MRI) in patients taking tocilizumab for polymyalgia rheumatica (PMR)
Patients We conducted a prospective, cross-sectional, multicenter study in patients with PMR included in the TENOR study (Tocilizumab Effect iN pOlymyalgia Rheumatica) [20] (ClinicalTrials.gov NCT01713842) between September 2012 and May 2014
Bursitis defined as a score ≥ 1 was identified by MRI at the shoulders in 26 joints (93%) and at the hips in 30 joints (100%)

Summary

Methods

Patients We conducted a prospective, cross-sectional, multicenter study in patients with PMR included in the TENOR study (Tocilizumab Effect iN pOlymyalgia Rheumatica) [20] (ClinicalTrials.gov NCT01713842) between September 2012 and May 2014. At one of the study centers (Brest), US and MRI of the shoulders and hips were performed at weeks 0, 2, and 12, using a standardized protocol. These imaging data form the basis for the study reported here. For the T2 STIR sequence at the shoulder, the matrix was 328 × 382 in the coronal plane and 524 × 210 in the axial plane; corresponding values at the hip were 356 × 420 and 468 × 264, respectively. Fields of view were 32 × 48 cm and 47 × 28 cm for coronal and axial imaging of the shoulder, respectively; corresponding values at the hip were 35 × 52 cm and 46 × 35 cm, respectively. Kappa values were interpreted as follows: < 0, no agreement; < 0.20, slight agreement; 0.21–0.40, fair agreement; 0.41–0.60, moderate agreement; 0.61–0.80, substantial agreement; and 0.81–1.00, almost perfect agreement

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