***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the efficacy and safety of shoulder corticosteroid injections in polymyalgia rheumatica ( PMR ) . METHODS Twenty consecutive patients with active PMR were r and omized into a 7 month , double blind , placebo controlled study . Patients received either bilateral shoulder injections of 40 mg of 6-methylprednisolone acetate or placebo ( 1 ml saline solution ) . Responders were treated weekly with the same regimen for a total of 4 bilateral injections and then followed for 6 months . Response was defined as a 70 % reduction in visual analog scale ( VAS ) score for pain and for patient and physician global assessment , and duration of morning stiffness . Bilateral shoulder magnetic resonance imaging ( MRI ) was performed at different times to evaluate the response of lesions to therapy . RESULTS All 10 corticosteroid treated patients responded to the first injection with a significant reduction in duration of morning stiffness , VAS pain scale , patient and physician global assessment , erythrocyte sedimentation rate , and C-reactive protein . Interleukin 6 serum levels were significantly reduced after the 2nd injection . In 5 patients , the response persisted throughout the followup period . The other 5 withdrew within 4 weeks after the 4th injection due to recurrence of symptoms . None of the 10 patients of the placebo group responded to the first injection . The difference between the 2 groups was significant ( p = 0.03 ) . No side effects were recorded . MRI showed marked improvement of shoulder lesions one week after first injection and an almost complete resolution one week after last injection in the responders . CONCLUSION Shoulder corticosteroid injections seem to be an effective and safe therapy for PMR Objective To assess the responsiveness of ultrasound ( US ) inflammatory findings in the shoulder and hip of patients with polymyalgia rheumatica ( PMR ) who started treatment with corticosteroids .  Methods Fifty-three patients with active PMR who started treatment with prednisone in six Spanish centres were prospect ively studied . The patients underwent clinical , laboratory and US assessment at baseline , 4 and 12 weeks . The US investigation consisted of detection and quantification of inflammatory findings in the shoulder and hip . The responsiveness of clinical , laboratory and US parameters was tested by the st and ardised response mean . Intraobserver and interobserver reliability between US investigators was assessed . Results At baseline , 34 patients ( 69 % ) had inflammation in at least one bilateral site . During the follow-up period , clinical , laboratory and US variables showed a parallel decrease . A significant decrease in US inflammatory parameters was found at week 4 ( p<0.001 ) . After 4 and 12 weeks of treatment with corticosteroids , US inflammatory findings showed similar or better sensitivity to change than clinical and laboratory markers of PMR activity . Intraobserver and interobserver intraclass correlation coefficients were 0.96 and 0.99 , respectively ( p<0.05 ) . Conclusion US may be a responsive additional tool in monitoring the response to corticosteroids in patients with PMR in daily practice and multicentre trials OBJECTIVES To evaluate the inflammatory involvement of lumbar interspinous bursae in patients with polymyalgia rheumatica ( PMR ) using magnetic resonance imaging ( MRI ) . METHODS Ten consecutive , untreated new patients with PMR and pain in the shoulder and pelvic girdles were investigated . Seven patients with spondyloarthritis ( 4 with psoriatic spondyloarthrits , one with entheropatic spondyloarthritis , and 2 with ankylosing spondylitis ) as well as 2 patients with spinal osteoarthritis and 2 patients with rheumatoid arthritis with lumbar pain served as controls .  MRI of lumbar spine  was performed in all PMR patients and controls . Nine patients ( 5 PMR patients and 4 controls ) also had  MRI  of the thoracic spine . RESULTS MRI evidence of interspinous lumbar bursitis was found in 9/10 patients with PMR and in 5/11 controls . A moderate to marked ( grade ≥2 on a semiquantitative 0 - 3 scale ) lumbar bursitis occurred significantly more frequently in patients with PMR than in control patients ( 60 % vs. 9 % , p=0.020 ) . In most of the patients and controls lumbar bursitis was found at the L3-L5 interspaces . Only 2 patients had bursitis at a different level ( one patient had widespread lumbar bursitis , and one control at L2-L4 ) . No interspinous bursitis was demonstrated by MRI of the thoracic spine in patients and controls . CONCLUSIONS Inflammation of lumbar bursae may be responsible for the low back pain reported by patients with PMR . The prominent inflammatory involvement of bursae including those of the lumbar spine supports the hypothesis that PMR may be a disorder affecting predominantly extra-articular synovial structures OBJECTIVE To determine if ultrasonography ( US ) and power Doppler ( PD ) may be useful in identifying polymyalgia rheumatica ( PMR ) patients with relapsing disease . METHODS For a mean of 41 months , 57 consecutive untreated patients with PMR were prospect ively assessed for relapses/recurrences . This cohort represented all the patients diagnosed over a 18-month period in one Italian secondary referral centre .  Clinical signs and symptoms as well as ESR and CRP were evaluated . US examination of the shoulders was performed in all 57 patients at diagnosis and after the onset of prednisone treatment ( mean 24 + /- 3 weeks ) .  Power Doppler ultrasonography ( PDUS ) was performed in 24 patients . Shoulder sonograms  were obtained according to st and ardized techniques . RESULTS Prednisone therapy significantly reduced the frequency and the degree of subacromial/subdeltoid bursitis , long head biceps tenosynovitis and glenohumeral synovitis . At diagnosis , a positive PD signal was observed more frequently in the subacromial/subdeltoid bursae ( 33 % ) . Prednisone therapy significantly reduced the frequency of patients with positive PD signal . Of the 44 patients in remission or with low disease activity at the time of the second US , 26 ( 59 % ) still had evidence of persistent inflammatory lesions . There was no association between the persistence of inflammation at US and relapses/recurrences ; in contrast , a positive PD signal at diagnosis was significantly associated with the occurrence of relapses/recurrences at follow-up . CONCLUSION Sub clinical inflammation detected by US persists in most PMR patients despite glucocorticoid treatment . PDUS may be useful to detect at diagnosis the patients with most active inflammation who have a higher risk of relapses/recurrences Abstract In a prospect i ve study , the glenohumeral joints of 51 patients ( aged 60 or above ) were examined , using ultrasonography .  Twenty-two patients were suffering from characteristic polymyalgia rheumatica ( PMR ) symptoms . In contrast , 29 other patients initially had similar complaints , but were diagnosed as having elderly onset rheumatoid arthritis ( EORA , rheumatoid factor negative ) upon development of typical symptoms . Ultrasound examination revealed glenohumeral joint inflammation in 40.9 % ( 9/22 ) of the patients with PMR and 65.5 % ( 19/29 ) of the patients with EORA . A discrete symmetrical biceps tendon sheath effusion was found in only three patients and unilateral in six patients with PMR . In contrast , 12 patients with EORA presented a massive effusion of the biceps tendon sheath , in some cases combined with a bilateral subdeltoid bursitis , and an intraarticular ( i.a . ) effusion/synovitis . To summarize our results : an i.a . effusion/synovitis , subdeltoid bursitis and biceps tendon sheath effusion were more frequent in patients with EORA , with a predominate symmetry and signs for massive inflammation . The typical ultrasonographic result in patients with PMR was a unilateral inflammation of the glenohumeral joint with predominate discrete biceps tendon sheath effusion and , in comparison with the EORA group , with signs of a low grade inflammation . We conclude that the results of our prospect i ve study might be helpful in the differentiation of PMR and a rheumatoid factor negative subgroup of EORA at the first time of manifestation where clinical overlaps can be observed . However , ultrasonography of the glenohumeral joints might be a good and helpful instrument of differentiation in both diseases OBJECTIVE To assess the characteristics of calcium pyrophosphate deposition disease ( CPDD ) with proximal involvement mimicking polymyalgia rheumatica ( PMR ) , and to identify the best predictive factors for the presence of a clinical pattern of CPDD in patients presenting with polymyalgia symptoms . METHODS Patients diagnosed with either PMR or CPDD at the Rheumatology Division of Hospital Meixoeiro ( Vigo , Spain ) over a 7-year period ( 1997 - 2003 ) were prospect ively followed for at least 12 months . RESULTS The study group comprised 118 patients with PMR features and 112 patients with CPDD . Eighty-two of the 118 patients with PMR manifestations were diagnosed as having pure PMR , and 36 met the diagnostic criteria for both PMR and CPDD . Patients with CPDD mimicking PMR were older ( P = 0.02 ) and had peripheral arthritis more frequently ( P = 0.004 ) than those with pure PMR . Radiologic osteoarthritic changes in the h and s and knees , including more advanced radiologic grade of knee osteoarthritis , and tendinous calcifications were more frequent in patients with PMR/CPDD ( P < 0.001 ) . The best predictive factors for the occurrence of this atypical pattern of CPDD in a patient presenting with PMR features were the age at diagnosis and the presence of tibiofemoral osteoarthritis , tendinous calcifications , and ankle arthritis . CONCLUSION Involvement of proximal joints may be the clinical presentation of CPDD . CPDD should be included in the spectrum of diseases mimicking PMR . The presence of tibiofemoral osteoarthritis , tendinous calcifications , and ankle arthritis are clues that may alert the clinician to the presence of CPDD in an elderly patient presenting with PMR manifestations OBJECTIVE Joint inflammation in polymyalgia rheumatica is regarded primarily as a disease of the synovial cavities and bursae , but the adjacent capsules and soft tissues have not been evaluated using sensitive imaging methods . We used fat suppression magnetic resonance imaging ( MRI ) to determine anatomical sites of inflammatory change in the shoulders of patients with early polymyalgia rheumatica ( PMR ) and a control group of patients with rheumatoid arthritis ( RA ) . METHODS Fourteen patients with PMR and 14 with RA ( a total of 20 shoulders in each group ) were evaluated .  T2 SPIR ( fat suppressed ) coronal oblique MRI sequences of the shoulders were performed . Scans were assessed for sites of joint effusion , bursitis , tenosynovitis , bone edema , and extracapsular soft tissue edema . Statistical analysis was performed using Fisher 's test . RESULTS Nine of 14 patients ( 10/20 joints ) with PMR but only 2/14 ( 2/20 joints ) with RA had prominent edema at extracapsular sites adjacent to the joint capsule or in the soft tissues ( p = 0.02 ) . Both groups had a comparable degree of joint effusion ( 18 PMR , 17 RA ) , bursitis ( 18 PMR , 16 RA ) , and tenosynovitis ( 3 PMR , 2 RA ) . CONCLUSION The only significant difference between the 2 groups was the presence of inflammatory change outside the joint cavity in patients with PMR . This may contribute to the diffuse nature of symptoms in PMR and have implication s for its pathogenesis OBJECTIVE To evaluate the impact of polymyalgia rheumatica ( PMR ) on clinical outcomes and quality of life ( QOL ) ; the relationship between laboratory measures and clinical outcomes , and changes in QOL ; and agreement between rheumatologists in confirming the initial diagnosis . METHODS We conducted a prospect i ve study of 129 participants in 8 hospitals in Engl and who met a modified version of the Jones and Hazleman criteria and had not started steroid therapy .  The main outcome measures were response to steroids  after 3 weeks ( minimum 50 % improvement in proximal pain , morning stiffness < 30 minutes , acute-phase response not elevated ) , relapses , QOL as measured by the Short Form 36 and Health Assessment Question naire , and diagnosis re assessment at 1 year . RESULTS At 3 weeks , 55 % of participants failed to meet our definition of a complete response to steroid therapy . Both physical and mental QOL at presentation were substantially lower than general population norms and improved by 12.6 ( 95 % confidence interval [ 95 % CI ] 10.8 , 14.4 ) and 11.2 ( 95 % CI 8.5 , 13.8 ) points , respectively , at 1 year . Proximal pain and longer morning stiffness were significantly associated with lower physical QOL during followup , whereas erythrocyte sedimentation rate was most strongly associated with lower mental QOL during followup . There was moderate agreement between clinicians in confirming the PMR diagnosis ( kappa coefficients 0.49 - 0.65 ) . CONCLUSION PMR is a heterogeneous disease with a major impact on Q 
    Output:
    
MRI and PET/CT revealed additional areas of inflammation in the spine and pelvis , including focal areas between the vertebrae and anterior to the hip joint , but the number of controls with inflammatory disease was inadequate for precise specificity estimates .