#2-10E. Enhancing Diagnostic Certainty in PMR using Advanced Imaging (Rheumatology, 2025)

How confident are you in your diagnosis of Polymyalgia Rheumatica (PMR), especially when clinical features are atypical or overlap with other conditions? This Mini-Review, "Imaging findings in polymyalgia rheumatica," explores the pivotal contribution of advanced imaging modalities—ultrasound, MRI, and PET—in defining the characteristic musculotendinous pathology of PMR. Traditionally, PMR diagnosis relied on symptoms and non-specific inflammatory markers, but modern techniques now clearly document the unique peri-articular distribution of inflammation in structures like the bursae and tendons. The key takeaway for clinicians is that imaging, particularly MRI and hybrid PET/CT, offers highly sensitive and specific findings that provide essential diagnostic certainty. For instance, MRI can identify pathognomonic peritendonitis and myofascial lesions. This knowledge is critical when evaluating patients with atypical presentations, non-response to standard therapy, or features suspicious for concomitant Giant Cell Arteritis (GCA). However, the authors critically note that despite the diagnostic advancements, further dedicated research is needed to determine the best approach for utilizing imaging to monitor disease activity and predict long-term clinical outcomes. Integrating these tools is crucial for refining your diagnostic strategy, ensuring reliable PMR confirmation in complex cases.

Citation: Owen CE, Nakos O. Imaging findings in polymyalgia rheumatica. Rheumatology. 2025. DOI: 10.1093/rheumatology/keae473.

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.