Imaging for diagnosis, monitoring and outcome prediction in polymyalgia rheumatica: a systematic literature review and meta-analysis informing an international task force
8 affiliations
- 114 Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
- 26 Health Economics and Decision Science, Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
- 3Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsus Medical University, Brunico, Italy
- 4Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 5Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- 6Department of Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
- 7Department of Rheumatology, Hospital of Bruneck, Brunico, Bozen, Italy
- 8Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Medical Specialities (Di.M.I.), University of Genoa, Genoa, Liguria, Italy
Abstract
Objective To summarise evidence on imaging for the diagnosis, monitoring and outcome prediction in polymyalgia rheumatica (PMR) to inform an international task force.Methods Six research questions across diagnostic, monitoring, prognostic and technical aspects were defined. A systematic literature review searched Ovid MEDLINE, Ovid EMBASE, Epistemonikos and the Cochrane Library (through July 2025), including prospective and retrospective cohort studies (≥20 patients) as well as case–control and cross-sectional studies for diagnostic aspects. Test performance was summarised descriptively and meta-analysed using bivariate random-effects models when ≥2 low or some concerns on risk-of-bias (RoB) studies were available.Results Forty-nine studies were included: 32 on diagnosis, 6 on monitoring, 13 on outcome prediction and 8 on technical aspects (some studies covered ≥1 aspect). No study was graded as low RoB. Diagnostic studies identified useful imaging lesions (eg, extracapsular and bilateral inflammatory patterns of shoulders and hips), but few were validated in independent cohorts. Diagnostic accuracy of positron emission tomography scores was reduced in the case of prior treatment and when used to differentiate PMR from other inflammatory diseases. Glucocorticoids substantially reduced sensitivity across modalities, highlighting the value of timely imaging when indicated. Data on monitoring and outcome prediction were sparse and heterogeneous.Conclusion This systematic literature review serves as a basis for the formulation of international recommendations on the use of imaging in PMR. Available evidence was heterogeneous and of limited quality but revealed distinct imaging lesions and scores that can support PMR diagnosis. Well-designed prospective studies and external validations are needed.
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BibTeX
@article{ramiro2026imaging,
title = {{Imaging for diagnosis, monitoring and outcome prediction in polymyalgia rheumatica: a systematic literature review and meta-analysis informing an international task force}},
author = {Sofia Ramiro and Louise Falzon and Christian Dejaco and Kornelis S M van der Geest and Sebastian E Sattui and Victoria Konzett and Milena Bond and Elvis Hysa},
journal = {RMD Open},
year = {2026},
month = oct,
doi = {10.1136/rmdopen-2026-006961},
url = {https://doi.org/10.1136/rmdopen-2026-006961},
note = {CC BY},
}
RIS
TY - JOUR
TI - Imaging for diagnosis, monitoring and outcome prediction in polymyalgia rheumatica: a systematic literature review and meta-analysis informing an international task force
AU - Sofia Ramiro
AU - Louise Falzon
AU - Christian Dejaco
AU - Kornelis S M van der Geest
AU - Sebastian E Sattui
AU - Victoria Konzett
AU - Milena Bond
AU - Elvis Hysa
PY - 2026
DA - 2026/10/23
JO - RMD Open
DO - 10.1136/rmdopen-2026-006961
UR - https://doi.org/10.1136/rmdopen-2026-006961
AB - Objective To summarise evidence on imaging for the diagnosis, monitoring and outcome prediction in polymyalgia rheumatica (PMR) to inform an international task force.Methods Six research questions across diagnostic, monitoring, prognostic and technical aspects were defined. A systematic literature review searched Ovid MEDLINE, Ovid EMBASE, Epistemonikos and the Cochrane Library (through July 2025), including prospective and retrospective cohort studies (≥20 patients) as well as case–control and cross-sectional studies for diagnostic aspects. Test performance was summarised descriptively and meta-analysed using bivariate random-effects models when ≥2 low or some concerns on risk-of-bias (RoB) studies were available.Results Forty-nine studies were included: 32 on diagnosis, 6 on monitoring, 13 on outcome prediction and 8 on technical aspects (some studies covered ≥1 aspect). No study was graded as low RoB. Diagnostic studies identified useful imaging lesions (eg, extracapsular and bilateral inflammatory patterns of shoulders and hips), but few were validated in independent cohorts. Diagnostic accuracy of positron emission tomography scores was reduced in the case of prior treatment and when used to differentiate PMR from other inflammatory diseases. Glucocorticoids substantially reduced sensitivity across modalities, highlighting the value of timely imaging when indicated. Data on monitoring and outcome prediction were sparse and heterogeneous.Conclusion This systematic literature review serves as a basis for the formulation of international recommendations on the use of imaging in PMR. Available evidence was heterogeneous and of limited quality but revealed distinct imaging lesions and scores that can support PMR diagnosis. Well-designed prospective studies and external validations are needed.
SN - 2056-5933
ER -