Study | Index test: imaging modality | Who performed index test, were they blinded to clinical data, was inter/intra-rater reliability reported? | Prospective study? | Does PMR spectrum appear realistic according to information given? Did any also have GCAs? | Consecutive selection of participants? | Comparator condition(s): realistic? | Reference standard; who performed it, when? | Did all participants receive all tests? | Free from incorporation bias? | Free from diagnostic review bias? | Did participants have index test before receiving glucocorticoid treatment? |
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Musculoskeletal ultrasound (MSK USS) | |||||||||||
Dasgupta et al15*† | MSK USS shoulders, hips | Rheumatologist or radiologist, one per site; reliability reported separately (Scheel et al, 2009); at some sites sonographer was clinical assessor | Yes | Yes; none had GCA | No | Yes: >50 years, <12 weeks’ history of bilateral shoulder pain, not felt to be PMR | Clinical diagnosis; by investigator; after 6 months | 5 PMR and 15 controls did not have scans | Yes—diagnosis made before USS, and assessors told not to use USS findings in making diagnosis | Sonographer and clinical assessor were sometimes same person | Yes |
Ruta et al39*† | MSK USS shoulders | Single rheumatologist-sonographer blinded to clinical data; reliability not reported | Yes | Maybe: relapsing PMR (new-onset bilateral painful shoulder and prior diagnosis PMR); none had GCA | Yes | Maybe: relapsing RA (new-onset bilateral painful shoulder and prior diagnosis of RA) | PMR: clinical diagnosis+Healey criteria; RA: ACR 2010 criteria; by treating rheumatologist | Yes | Yes | Yes | No; were on ≤10 mg prednisolone; most were on 2–4 mg; treatment did not seem to affect USS findings |
Falsetti et al44† | MSK USS at multiple sites | Single rheumatologist-sonographer, not blinded to clinical data; reliability not reported | Yes | Yes: all participants referred from primary care with polymyalgic syndrome fulfilling Bird criteria; one developed GCA later. All participants drawn from this same population (single-gate study design). 29/61 (47.5%) had final diagnosis PMR. Many of those with RA were seropositive | Clinical diagnosis; by 2 rheumatologists, after 1 year | Yes | No | No | Yes | ||
Cantini et al34 | MSK USS hips and MRI pelvic girdle | Two radiologists for each test (unclear whether these were same people), unclear whether blinded to clinical data (note alternating recruitment of cases/2 controls); reliability not reported | Yes | A subset: PMR with pelvic girdle involvement; 3 also had biopsy-proven GCA; none developed RA (1987 ACR criteria) after average follow-up 26 months | Yes | Maybe: next 2 consecutive outpatients >50 years with active rheumatic disease (RA/PsA/OA) and bilateral hip ache | Clinical diagnosis+Healey criteria PMR, followed up to ensure no evolution to RA | Only 10 of 40 controls had MRI (unclear how these were selected) | Yes | Unclear | Yes for PMR; unclear for controls |
Frediani 2002†45 | MSK USS at multiple sites | Two rheumatologist-sonographers, blinded to diagnosis; “medium rates concordance [agreement]” reported but no test statistics quoted | Yes | Yes: “PMR patients with a relatively certain diagnosis”—Healey criteria; 2 also had GCA | Yes | No: RA (ARA 1987 criteria); SpA (ESSG criteria) | Clinical diagnosis+Healey criteria PMR; 2-year follow-up to confirm diagnosis | Yes | Yes | No, but diagnosis not changed after USS | Yes |
Cantini et al33 | MSK USS shoulders | Two radiologists together, blinded to clinical diagnosis (but note recruitment of 2 controls after each case); reliability not reported | Yes | Yes: >1 month pain neck and shoulder girdle; morning stiffness> 1 h; ESR>40; 5 also had biopsy proven GCA; follow-up for mean 8 months to exclude those fulfilling 1987 ARA RA criteria | Yes | Maybe: next 2 consecutive outpatients >50 years with bilateral shoulder aching, stiffness (RA/PsA/SpA/OA/FM/CTD) | Clinical diagnosis+Healey criteria; by 1 of 4 rheumatologists; follow-up to confirm diagnosis | Yes | Yes | Unclear; but participant selection protocol implies participants did not switch between case/control groups | Yes for PMR, unclear for controls |
Coari et al38 | MSK USS shoulders | Two rheumatologist-sonographers, unclear whether blinded to clinical data; reliability not reported | Not stated but implied | No: treated PMR; not stated whether any had GCA | Not stated | No: treated; one-third of RA patients erosive | Clinical diagnosis (ARA 1987 for RA); not stated by whom or whether followed up | Only PMR each had both shoulders scanned; unit of analysis was shoulder not patient | Yes | Unclear | No |
Lange et al46 | MSK USS shoulders | Not stated; reliability not reported | Not stated but implied | Yes: >60 years, pain and several hours’ morning stiffness of shoulders, neck and/or pelvic girdle, limited motion in neck and shoulder, ESR>45, response to prednisolone 30 mg or less); 6 had headache, 2 had biopsy-proven GCA | Not stated | Maybe: “initially had similar complaints (to the PMR cases) … involvement of arthritis in additional joints and bony erosions” | Clinical diagnosis; not stated by whom or whether followed up | Yes | Yes (implied but not stated) | Unclear | Yes (implied but not stated) |
Lange et al47 | MSK USS shoulders | Not stated; reliability not reported | Not stated but implied | Yes: >60 years, pain and several hours’ morning stiffness of shoulders, neck and/or pelvic girdle, >4 weeks duration symptoms, ESR>45, response to prednisolone 30 mg or less); 5 had headache, 4 had biopsy-proven GCA | Not stated | Maybe: “initially had similar complaints (to the PMR cases) … involvement of arthritis in additional joints and bony erosions” | Clinical diagnosis; not stated by whom or whether followed up | Yes | Yes (implied but not stated) | Unclear | Yes (implied but not stated) |
Macchioni et al23 | MSK USS shoulders, hips | Single rheumatologist-sonographer; blinding to clinical data not stated; reliability not reported | No | Yes: patients seen with suspected PMR; patients with GCA excluded | Yes | No: patients in early arthritis clinic; no requirement for comparable symptoms | Clinical diagnosis; confirmed at 1 year by 2 lead authors | Yes | Unclear | No | Yes |
MRI | |||||||||||
Salvarani et al37 | 1.5 T MRI lumbar spine (bursitis) | Radiologist; blinded to clinical findings and diagnosis; reliability not reported | Yes | A subset: PMR by Chuang criteria+pelvic girdle symptoms; none had GCA | Yes | Maybe: treated patients with lumbar pain (SpA/OA/RA) | Clinical diagnosis+Chuang criteria, followed up for 10–16 months to exclude RA (ARA 1987) or other conditions | Yes | Yes | Yes | Yes for PMR, unclear for controls |
Cimmino et al40 | 0.2 T MRI hands (extremity MRI)—tenosynovitis | Two rheumatologists and one PhD, blinded to diagnosis; reliability not reported but Parodi et al 2006 quoted in support | Yes | Yes: PMR by Chuang criteria; none had GCA | Yes for PMR, not for controls | No: Healthy controls of similar ages, no mention of symptoms | Clinical diagnosis+Chuang criteria, followed for 8–124 months to exclude GCA, RA and other erosive disease | Yes but 4 hands could not be interpreted | Yes | Yes | Yes |
Salvarani et al36 | 1 T MRI cervical spine (bursitis) | One radiologist, blinded to clinical data and diagnosis (but note alternating recruitment of cases, controls); reliability not reported | Yes | Yes: PMR (reference Salvarani review 2002); none had GCA | Yes | No: Next patients with neck pain seen after PMR patients | Clinical diagnosis+criteria; followed for 10–16 months to exclude other conditions | Yes | Yes | Yes | Yes |
Marzo et al13 | 1.5 T MRI of most swollen hand | One assessor per MRI feature, blinded to clinical data; reliability not reported | Yes | No: Bird criteria+MCP joint swelling | Yes for RA, not stated for PMR | No: ARA 1987 criteria+MCP joint swelling | Clinical diagnosis+Bird criteria; followed for mean of 6 years | Yes | Yes | Yes | Yes except for one PMR patient |
McGonagle et al12 | 1.5 T MRI shoulder | Two radiologists, blinded to clinical data; reliability not reported | Yes | Yes: untreated PMR and bilateral shoulder disease without peripheral arthropathy | No | No: early RA fulfilling 1987 ARA criteria | Clinical diagnosis; no follow-up reported to exclude other conditions | Only 6/14 PMR patients had both shoulders imaged | Yes | Yes | Yes for PMR; not for 8/14 RA |
Salvarani et al48 | 0.5 T MRI shoulder | One radiologist, blinded to clinical data and diagnosis; reliability not reported | Yes | Yes: Healey criteria PMR; none had GCA | Unclear | No: elderly-onset RA by modified 1987 ARA criteria, with clinical evidence shoulder involvement | Clinical diagnosis+Healey criteria; no follow-up reported to exclude other conditions | The first 4 PMR had both shoulders imaged; after that only one shoulder | Yes | Yes | Yes |
18F-fluorodeoxyglucose—positron emission tomography (FDG-PET) | |||||||||||
Yamashita et al35 | FDG-PET/CT whole body | Not stated who reported test; unclear whether blinded to clinical info; reliability not reported | No | No: inpatients, having PET/CT to exclude other diseases for example, suspected malignancy; none had clinical evidence GCA | Yes | No (other rheumatic diseases with suspected malignancy; 11/17 RA) | Clinical diagnosis+Chuang+Healey criteria; length of follow-up not specified | Yes | Unclear | No | Yes for PMR, not stated for controls |
Camellino et al25† | FDG-PET/CT | Rheumatologist and radiologist, blinded to clinical data (pers comm); reliability not reported | Yes | Little information on how patients were identified | Yes | No (65 matched controls with no inflammatory disease; 10 with treated RA) | Fulfilled Bird and ACR/EULAR criteria; median follow-up 22 months | Yes | Yes | Probably | Yes for PMR/controls, no for RA |
Takahasi et al24† | FDG-PET/CT | Radiologists, blinded to clinical data [pers comm]; reliability not reported | No | No: inpatients and outpatients, having PET/CT to exclude other diseases, for example, suspected malignancy; none had clinical evidence of GCA | Yes | Maybe (untreated, elderly-onset RA) | Diagnosed by attending doctors prior to PET/CT (pers comm); diagnosis did not change on follow-up (pers comm). and verified by classification criteria | Yes | Yes | Yes | Yes |
The PET or PET/CT studies that did not report data extractable into 2×2 table format are not listed here. Before-after or prognostic studies, if they did not report data extractable into 2×2 table format, are not reported here.
Incorporation bias means where the imaging (index test) informs the diagnosis (reference standard).
Diagnostic review bias means where the diagnosis (reference standard) was carried out or verified with knowledge of the imaging (index test).
*Further data were supplied by corresponding authors on request.
†Methodological details supplied by corresponding authors on request.
ACR, American College of Rheumatology; ARA, American Rheumatism Association; CTD, connective tissue disease; ESR, erythrocyte sedimentation rate; EULAR, the European League Against Rheumatism; FM, fibromyalgia; GCA, giant cell arteritis; MCP, metacarpophalangeal; OA, osteoarthritis; PET/CT, positron emission tomography CT; PMR, polymyalgia rheumatica; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SpA, spondyloarthropathies.