Jean-Patrick Laporte1,2, Florent Garrigues1,2, Anaïs Huwart1,2, Sandrine Jousse-Joulin1,2, Thierry Marhadour1,2, Dewi Guellec1,2, Divi Cornec1,2, Valérie Devauchelle-Pensec1,2, Alain Saraux3,4. 1. 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. 2. J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest. 3. 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. alain.saraux@chu-brest.fr. 4. J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest. alain.saraux@chu-brest.fr.
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).
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).
Entities:
Keywords:
FASCIITIS; MAGNETIC RESONANCE IMAGING; MYOSITIS; POLYMYALGIA RHEUMATICA
Authors: K S M van der Geest; G Treglia; A W J M Glaudemans; E Brouwer; F Jamar; R H J A Slart; O Gheysens Journal: Eur J Nucl Med Mol Imaging Date: 2020-12-28 Impact factor: 9.236