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Interspinous bursitis is common in polymyalgia rheumatica, but is not associated with spinal pain.

Camellino D, Paparo F, Morbelli S, Cutolo M, Sambuceti G, Cimmino MA - Arthritis Res. Ther. (2014)

Bottom Line: No correlation was found between uptake and spontaneous or provoked pain.However, it is not associated with clinical symptoms and can hardly explain the spinal pain reported by the patients.Cervical pain is more frequent than lumbar pain in PMR patients and may be caused by shoulder girdle involvement.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Polymyalgia rheumatica (PMR) is a common inflammatory disease in older people characterized by shoulder and/or pelvic girdle, and cervical and, occasionally, lumbar pain. Interspinous bursitis has been suggested as a potential cause of spinal symptoms. We evaluated, by 18 F-fluorodeoxyglucose (FDG) positron emission tomography integrated with computed tomography (PET/CT), the vertebral structures involved in PMR in a cohort of consecutive, untreated patients.

Methods: Sixty-five consecutive patients with PMR were studied. After a standardized physical examination, which included evaluation of pain and tenderness in the vertebral column, they underwent FDG-PET/CT. Sites of increased uptake and their correlation with spontaneous and provoked pain were recorded. For comparison, FDG-PET/CT was performed also in 65 age- and sex-matched controls and in 10 rheumatoid arthritis (RA) patients.

Results: The most frequent site of spontaneous and provoked pain was the cervical portion. FDG uptake was more frequent in the lumbar portion than at any other location, and in the cervical rather than in the thoracic portion (P <0.0001). No correlation was found between uptake and spontaneous or provoked pain. There was an association between presence of cervical and lumbar bursitis (r = 0.34, P = 0.007). None of the control patients and one out of ten RA patients showed interspinous bursitis.

Conclusions: Interspinous bursitis is a frequent finding in the lumbar spine of patients with PMR. However, it is not associated with clinical symptoms and can hardly explain the spinal pain reported by the patients. Cervical pain is more frequent than lumbar pain in PMR patients and may be caused by shoulder girdle involvement.

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The localization of bursitis in the interspinous spaces is indicated by the colored box. Each column represents a patient with bursitis.
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Fig4: The localization of bursitis in the interspinous spaces is indicated by the colored box. Each column represents a patient with bursitis.

Mentions: Median disease duration was 68 days (range 4 to 486 days), median morning stiffness was 60 minutes (range 15 to 360 minutes), median CRP was 36 mg/L (range 2 to 149 mg/L), and median ESR was 59 mm/h (range 10 to 120 mm/h). Clinically, the most frequent site of spontaneous and provoked pain was the cervical spine (Figure 1). FDG uptake suggestive of interspinous bursitis was seen only in the cervical and lumbar spine. It occurred in six patients (9%) at the cervical level (Figure 2) and in 30 (46%) at the lumbar level (Figure 3) (P <0.0001 for comparison between lumbar spine and the other locations, and between cervical and thoracic spine). No uptake was present in the vertebral column of control patients; in comparison with them, PMR patients showed more frequently cervical (P = 0.04) and lumbar (P = 0.001) bursitis. One patient with RA showed interspinous bursitis between lumbar vertebrae 3 to 4. Thirty-one out of 65 (47.7%) PMR patients showed interspinous bursitis in comparison with one out of ten (10%) RA patients, (P = 0.037). PMR patients, had uptake scores higher in the lumbar than in the cervical spine (1.3 ± 1.2 vs. 0.3 ± 0.8, P <0.0001). Uptake was more frequently observed at cervical vertebrae 3 to 6 and lumbar vertebrae 4 to 5. The number and location of the involved bursae in the individual patients is shown in Figure 4. No association was found between FDG uptake and spontaneous or provoked pain. Cervical and lumbar bursitis correlated (r = 0.34, P = 0.007) and often coexisted in the same patient. No correlation was found between uptake in the vertebral column and age, sex, disease duration, morning stiffness, CRP and ESR, or peripheral arthritis. Baastrup’s syndrome was not identified in any of these patients or in controls. Carotid artery vasculitis was seen in only three out of 65 (4.6%) patients, but was not associated with cervical pain. Of these three patients with vasculitis, one had pain but no tenderness of the cervical column, another had tenderness but no pain, and the last one had neither symptom.Figure 1


Interspinous bursitis is common in polymyalgia rheumatica, but is not associated with spinal pain.

Camellino D, Paparo F, Morbelli S, Cutolo M, Sambuceti G, Cimmino MA - Arthritis Res. Ther. (2014)

The localization of bursitis in the interspinous spaces is indicated by the colored box. Each column represents a patient with bursitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4265351&req=5

Fig4: The localization of bursitis in the interspinous spaces is indicated by the colored box. Each column represents a patient with bursitis.
Mentions: Median disease duration was 68 days (range 4 to 486 days), median morning stiffness was 60 minutes (range 15 to 360 minutes), median CRP was 36 mg/L (range 2 to 149 mg/L), and median ESR was 59 mm/h (range 10 to 120 mm/h). Clinically, the most frequent site of spontaneous and provoked pain was the cervical spine (Figure 1). FDG uptake suggestive of interspinous bursitis was seen only in the cervical and lumbar spine. It occurred in six patients (9%) at the cervical level (Figure 2) and in 30 (46%) at the lumbar level (Figure 3) (P <0.0001 for comparison between lumbar spine and the other locations, and between cervical and thoracic spine). No uptake was present in the vertebral column of control patients; in comparison with them, PMR patients showed more frequently cervical (P = 0.04) and lumbar (P = 0.001) bursitis. One patient with RA showed interspinous bursitis between lumbar vertebrae 3 to 4. Thirty-one out of 65 (47.7%) PMR patients showed interspinous bursitis in comparison with one out of ten (10%) RA patients, (P = 0.037). PMR patients, had uptake scores higher in the lumbar than in the cervical spine (1.3 ± 1.2 vs. 0.3 ± 0.8, P <0.0001). Uptake was more frequently observed at cervical vertebrae 3 to 6 and lumbar vertebrae 4 to 5. The number and location of the involved bursae in the individual patients is shown in Figure 4. No association was found between FDG uptake and spontaneous or provoked pain. Cervical and lumbar bursitis correlated (r = 0.34, P = 0.007) and often coexisted in the same patient. No correlation was found between uptake in the vertebral column and age, sex, disease duration, morning stiffness, CRP and ESR, or peripheral arthritis. Baastrup’s syndrome was not identified in any of these patients or in controls. Carotid artery vasculitis was seen in only three out of 65 (4.6%) patients, but was not associated with cervical pain. Of these three patients with vasculitis, one had pain but no tenderness of the cervical column, another had tenderness but no pain, and the last one had neither symptom.Figure 1

Bottom Line: No correlation was found between uptake and spontaneous or provoked pain.However, it is not associated with clinical symptoms and can hardly explain the spinal pain reported by the patients.Cervical pain is more frequent than lumbar pain in PMR patients and may be caused by shoulder girdle involvement.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Polymyalgia rheumatica (PMR) is a common inflammatory disease in older people characterized by shoulder and/or pelvic girdle, and cervical and, occasionally, lumbar pain. Interspinous bursitis has been suggested as a potential cause of spinal symptoms. We evaluated, by 18 F-fluorodeoxyglucose (FDG) positron emission tomography integrated with computed tomography (PET/CT), the vertebral structures involved in PMR in a cohort of consecutive, untreated patients.

Methods: Sixty-five consecutive patients with PMR were studied. After a standardized physical examination, which included evaluation of pain and tenderness in the vertebral column, they underwent FDG-PET/CT. Sites of increased uptake and their correlation with spontaneous and provoked pain were recorded. For comparison, FDG-PET/CT was performed also in 65 age- and sex-matched controls and in 10 rheumatoid arthritis (RA) patients.

Results: The most frequent site of spontaneous and provoked pain was the cervical portion. FDG uptake was more frequent in the lumbar portion than at any other location, and in the cervical rather than in the thoracic portion (P <0.0001). No correlation was found between uptake and spontaneous or provoked pain. There was an association between presence of cervical and lumbar bursitis (r = 0.34, P = 0.007). None of the control patients and one out of ten RA patients showed interspinous bursitis.

Conclusions: Interspinous bursitis is a frequent finding in the lumbar spine of patients with PMR. However, it is not associated with clinical symptoms and can hardly explain the spinal pain reported by the patients. Cervical pain is more frequent than lumbar pain in PMR patients and may be caused by shoulder girdle involvement.

Show MeSH
Related in: MedlinePlus