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Research ArticleVasculitis

Localized Myofascial Inflammation Revealed by Magnetic Resonance Imaging in Recent-onset Polymyalgia Rheumatica and Effect of Tocilizumab Therapy

Jean-Patrick Laporte, Florent Garrigues, Anaïs Huwart, Sandrine Jousse-Joulin, Thierry Marhadour, Dewi Guellec, Divi Cornec, Valérie Devauchelle-Pensec and Alain Saraux
The Journal of Rheumatology December 2019, 46 (12) 1619-1626; DOI: https://doi.org/10.3899/jrheum.180958
Jean-Patrick Laporte
From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d’Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.
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Florent Garrigues
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Anaïs Huwart
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Sandrine Jousse-Joulin
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Thierry Marhadour
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Dewi Guellec
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Divi Cornec
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Valérie Devauchelle-Pensec
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Alain Saraux
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  • For correspondence: alain.saraux@chu-brest.fr
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Abstract

Objective. To assess the prevalence of myofascial inflammatory lesions visible by magnetic resonance imaging (MRI) and their changes after tocilizumab (TCZ) therapy in active polymyalgia rheumatica (PMR).

Methods. We conducted a posthoc analysis of data from the TENOR study of TCZ monotherapy in PMR. The 18 patients each received TCZ injections at weeks 0, 4, and 8. The shoulder and pelvic girdles were assessed at baseline then at weeks 2 and 12 using T1- and T2- short-tau inversion recovery–weighted MRI. Radiologists blinded to patient data assessed each muscle group for localized myofascial inflammation on baseline, Week 2, and Week 12 MRI. Reproducibility was estimated by having 2 radiologists assess the Week 2 MRI of 13 patients, then computing the κ coefficient.

Results. For myofascial lesion detection, intraobserver reproducibility was almost perfect (κ = 0.890) and interobserver reproducibility was substantial (κ = 0.758). At baseline, all patients had at least 1 inflammatory myofascial lesion; sites involved were the shoulder in 10 (71.4%) patients, hip in 13 (86.7%), ischial tuberosity in 9 (60.0%), and pubic symphysis in 12 (80.0%). Sites involved at Week 12 were the shoulder in 8 patients (53.3%), hip in 5 (33.3%), ischial tuberosity in 1, and pubic symphysis in 3 (20.0%). At Week 12, of 103 muscle groups studied in all, 43 (41.7%) had no inflammatory lesions, compared to 33 at baseline (p = 0.002); improvements were noted in 66 (64.1%) muscle groups, worsening in 2 (1.9%), no change in 35 (34.0%; p = 0.034).

Conclusion. Localized myofascial inflammatory lesions are common in recent-onset PMR and improve during TCZ therapy. Clinicaltrials.gov (NCT01713842).

Key Indexing Terms:
  • MAGNETIC RESONANCE IMAGING
  • POLYMYALGIA RHEUMATICA
  • MYOSITIS
  • FASCIITIS
  • Accepted for publication February 20, 2019.
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The Journal of Rheumatology
Vol. 46, Issue 12
1 Dec 2019
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Localized Myofascial Inflammation Revealed by Magnetic Resonance Imaging in Recent-onset Polymyalgia Rheumatica and Effect of Tocilizumab Therapy
Jean-Patrick Laporte, Florent Garrigues, Anaïs Huwart, Sandrine Jousse-Joulin, Thierry Marhadour, Dewi Guellec, Divi Cornec, Valérie Devauchelle-Pensec, Alain Saraux
The Journal of Rheumatology Dec 2019, 46 (12) 1619-1626; DOI: 10.3899/jrheum.180958

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Localized Myofascial Inflammation Revealed by Magnetic Resonance Imaging in Recent-onset Polymyalgia Rheumatica and Effect of Tocilizumab Therapy
Jean-Patrick Laporte, Florent Garrigues, Anaïs Huwart, Sandrine Jousse-Joulin, Thierry Marhadour, Dewi Guellec, Divi Cornec, Valérie Devauchelle-Pensec, Alain Saraux
The Journal of Rheumatology Dec 2019, 46 (12) 1619-1626; DOI: 10.3899/jrheum.180958
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Keywords

MAGNETIC RESONANCE IMAGING
POLYMYALGIA RHEUMATICA
MYOSITIS
FASCIITIS

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  • MYOSITIS
  • FASCIITIS

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