MRI in PMR diagnosis

[Anna135]

I am wondering if anyone has had an MRI that showed evidence of PMR?

I have been experiencing symptoms of PMR since February (stiffness and pain/aching in my muscles in neck, shoulders and hips), and my rheumatologist has ordered X-rays of hip and shoulders as well as MRI of c-spine (my neck and shoulders are my worst areas of pain).

I think she is trying to look for evidence of arthritis, but I wonder if PMR is also likely to show up on the MRI or not. It really seems more likely to be PMR in my mind, given that I already have GCA, but I guess in her mind arthritis is the first assumption due to my younger age (37).

[Surami2020]

An MRI on my knee is what lead me on the journey to being diagnosed eventually with PMR. The MRI showed excessive inflammation of the femur head and my orthopedic surgeon thought I may have had my myeloma. So lots of blood tests and 8 months later with increasing symptoms I had PMR.

[Anna135 in reply to Surami2020]

Interesting, thank you.

[PMRpro Ambassador]

As far as I can see, gadolinium-enhanced MRI (i.e. using i.v. contrast) may be useful for the accurate diagnosis of PMR as it will show bursitis etc in the shoulders:

consultant360.com/exclusive...

but that can occur in other things too. A plain MRI probably won't show PMR but it will rule out other possible causes of the shoulder symptoms.

How did she make the GCA diagnosis? Getting a diagnosis of that at your age is usually awfully difficult. Surely they should consider Takayasu's arteritis at your age? And that can cause muscle aches and pains too - just as large vessel vasculitis does. I know there are doctors who think you have to be Asian to have it but that isn't the case and it is found worldwide.

[Anna135 in reply to PMRpro]

This is an MRI without contrast, so I guess the odds of it showing anything are greatly reduced then.

I wasn't diagnosed by my current rheumatologist, it was back in 2014 while I was travelling overseas. I had blood tests and a temple ultrasound. Nobody has ever suggested TAK - maybe as my symptoms were classic GCA with the temple pain and tenderness on one side, jaw claudication, and scalp so sensitive that I couldn't brush my hair or put on sunglasses.

My GCA symptoms have been mostly in remission for the last 2.5 years (I've had a few tiny flare ups for a few days but no relapses in that time), and then these PMR symptoms only started 6 months ago very suddenly and dramatically, so it seems more like the beginning of something new.

[PMRpro Ambassador in reply to Anna135]

Looking forward to hearing what they decide - do get back to us

[Anna135 in reply to PMRpro]

Yes, I will 😊

[SheffieldJane]

In my case, it was more a process of deduction. Cancelling out everything else it could be. None of my many tests showed evidence of PMR, only inflammation in the blood tests at the very ( pre-Pred) beginning. GCA and PMR are so linked as to be possibly the same disease affecting different arteries. My GCA ( Large Cell Vasculitis not Cranial) showed up during a specialist ultrasound scan, in my arm pit. I believe that some forms of Vasculitis are more common in young people ( Takayasu’s) Is this being explored? I think my diagnosis was a fluke, I had no jaw symptoms or visual symptoms. Mainly, I couldn’t get off Pred without feeling very constitutionally unwell.

[Anna135 in reply to SheffieldJane]

Yes, I've heard a lot of people get diagnosed via elimination of all the other possibilities first - maybe that will be the case for me as well.

My symptoms at the beginning were very suggestive of GCA, with temporal involvement, jaw claudication, and very sensitive scalp, so I think that's why no one has talked about TAK as an alternative for me.

What dose of prednisone were you on for PMR when the ultrasound showed GCA in your armpit? I know that being on prednisone can make it very hard to find it on ultrasound or biopsy, so that's great and definitely lucky you were still able to have it found and diagnosed.

[PMRpro Ambassador]

I read today while looking up something else that ultasound results may also be compromised after the patients had been on higher dose pred for a few weeks in that the halo sign may disappear. I thought it was here in Rec 3:

ard.bmj.com/content/77/5/636

but apparently not - though they do say imaging should be done as early as possible.

Yes it is Duplex ultrasound - that is the form used to create pictures as opposed to measure moving things like blood.

[SheffieldJane]

I was down to 3 mgs when I had the ultrasound test. The technician had been specially trained to spot GCA. I am not sure if my low dose was a factor.

[Nerak12]

Hi Anna. My Rheumatologist has recently requested a gadolinium-enhanced MRI for me, because I am experiencing some new pains which he suspects are unrelated to PMR. Not happening until 17th Sept, but I am eagerly awaiting outcome of scan as I’m in lot of pain and need to know what’s causing it. Uncertainty is the worst thing! Hope you get some answers soon.

[Anna135 in reply to Nerak12]

Oh, I hope you get some answers. It's not fun at all being in pain. I'd be very interested to hear how the MRI goes for you.

[Nerak12 in reply to Anna135]

Thanks Anna. Same for you too. My report back will be probably be on my ever lengthening DEXA Dilemma thread. Although I might start a MRI Madness one, if I can’t wake-up my Rheumatologist and persuade him to develop some better interpersonal and comms skills soon!🤦🏻‍♀️