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Laporte JP, Garrigues F, Huwart A, Jousse-Joulin S, Marhadour T, Guellec D, Cornec D, Devauchelle-Pensec V, Saraux A. Localized Myofascial Inflammation Revealed by Magnetic Resonance Imaging in Recent-onset Polymyalgia Rheumatica and Effect of Tocilizumab Therapy. J Rheumatol 2019; 46:1619-1626. [PMID: 30877202 DOI: 10.3899/jrheum.180958] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 11/22/2022]
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).
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Affiliation(s)
- 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.,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
| | - Florent Garrigues
- 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.,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
| | - Anaïs Huwart
- 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.,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
| | - Sandrine Jousse-Joulin
- 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.,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
| | - Thierry Marhadour
- 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.,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
| | - Dewi Guellec
- 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.,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
| | - Divi Cornec
- 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.,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
| | - Valérie Devauchelle-Pensec
- 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.,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
- 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. .,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.
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