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Proximal Bursitis in Active Polymyalgia Rheumatica

Carlo Salvarani, MD; Fabrizio Cantini, MD; Ignazio Olivieri, MD; Libero Barozzi, MD; Luigi Macchioni, MD; Laura Niccoli, MD; Angela Padula, MD; Massimo De Matteis, MD; and Pietro Pavlica, MD
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From the Azienda Ospedaliera Arcispedale S. Maria Nuova, Reggio Emilia, Italy; the Ospedale di Prato, Prato, Italy; and the Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy. Requests for Reprints: Carlo Salvarani, MD, Unita Reumatologica, 2 Divisione di Medicina Interna, Azienda Ospedaliera Arcispedale S. Maria Nuova, V.le Umberto 1 degrees N50, 42100 Reggio Emilia, Italy. Current Author Addresses: Drs. Salvarani, Padula, and Macchioni: Unita Reumatologica, 2 Divisione di Medicine Interna, Azienda Ospedaliera Arcispedale S. Maria Nuova, Reggio Emilia, Italy. Drs. Cantini and Niccoli: Unita Reumatologica, 2 Divisione di Medicina Interna, Ospedale di Prato, Prato, Italy.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(1):27-31. doi:10.7326/0003-4819-127-1-199707010-00005
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Background: The cause of musculoskeletal symptoms in the proximal extremities of patients who have polymyalgia rheumatica is not completely understood. The diffuse and severe discomfort can only be partially explained by the mild joint synovitis that is observed in these patients.

Objective: To determine the involvement of the synovial structures of the shoulder girdle of patients who have active symptoms of polymyalgia rheumatica.

Design: Case-control study.

Setting: 2 secondary referral centers of rheumatology.

Patients: 13 case-patients who had active symptoms of polymyalgia rheumatica seen during a 6-month period, 9 control-patients who had early symptoms of elderly-onset rheumatoid arthritis, and 10 age-matched healthy controls.

Measurements: Magnetic resonance imaging of the shoulder was done on the 13 case-patients, 9 control-patients, and 10 healthy controls.

Results: The frequency of subacromial and subdeltoid bursitis was significantly higher in the case-patients (who had polymyalgia rheumatica) than in the control-patients (who had elderly-onset rheumatoid arthritis). The frequencies of synovitis of the joints and tenosynovitis of the biceps did not significantly differ between the 13 case-patients and the 9 control-patients. None of the healthy controls showed evidence of fluid accumulation in the joints, bursae, or sheaths of the long head of the biceps.

Conclusions: Inflammation of subacromial and subdeltoid bursae in association with synovitis of the glenohumeral joints and tenosynovitis of the biceps may contribute to the diffuse discomfort in the shoulder girdle observed in patients with polymyalgia rheumatica.

Figures

Grahic Jump Location
Figure 1.
Magnetic resonance images of patients with polymyalgia rheumatica.arrowsarrows

Coronal T1-weighted (A) and axial T2-weighted (B) images of the left shoulder show severe subacromial and subdeltoid bursitis ( ). Coronal T1-weighted (C) image of the left shoulder shows mild subacromial bursitis ( ). Axial T2-weighted (D) image of the left shoulder shows moderate subdeltoid bursitis (solid white arrows), mild joint effusion (solid black arrow), and severe tenosynovitis of the long head of the biceps (open black arrow).

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