Age / Sex : 67 / M

Polymyalgia Rheumatica

Discussion

Findings:

Effusion in bilateral hip joints with capsular/pericapsular increased T2 signal and enhancement.

Increased T2 signal and enhancement of the muscles around both hip joints, and also extends to the thigh. Prominent increased T2 signal along the tendons and fascia, involving bilateral rectus femoris, vastus lateralis and hamstrings.

Bilateral facet synovitis in lumbar spine.
 

Differential Diagnosis: Non-specific synovitis of bilateral hip including septic arthritis and non-infectious inflammatory arthritis.
 

Diagnosis: Polymyalgia Rheumatica

Discussion:

 Polymyalgia rheumatica (PMR) is an inflammatory disease that affects people over the age of 50. The peak incidence occurs between ages 70 and 80 people over 50 years. Women are affected two to three times more often than men. There is a close relation to giant cell arteritis. 

Symptoms : pain and stiffness in the neck, shoulders, upper arms, thighs and hips

Fatigue and weakness.

Low grade fever

Flu-like syptoms

Lab : elevated ESR and CRP

Diagnosis : Definite PMR requires the presence of all criteria

1. Age >50 years

2.  Bilateral aching/tenderness for one month of:

(a) Neck or torso

(b) Shoulders or upper arms

(c) Hips or thighs

   3.  Initial Westergren sedimentation rate >40 mm/h

   4.  Exclusion of other diagnoses
 

Imaging findings :

-       Classical : synovitis and bursitis at shoulders and hip joints, facet synovitis in the spine.

-       Possible imaging findings : Atypical myotendinous junction edema, Adhesive capsulitis, Predominance of peritendinitis over tendinopathies.
 

References: R. Leao, L. C. Zattar-Ramos, E. L. Bizetto et al. Imaging of polymyalgia rheumatica: what the radiologist should know, Educational Poster in ESSR 2016.