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Lumbar bursitis contributed to polymyalgia rheumatica patients’ low back pain
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Lumbar bursitis was a likely cause of low back pain reported by patients with polymyalgia rheumatica, according to study results.
Researchers studied 10 treatment-naive patients with symptoms of polymyalgia rheumatica (PMR; median age at diagnosis, 74 years; seven women) and shoulder and pelvic girdle pain seen at a rheumatology unit in Italy. A control group included seven patients with spondylarthritis (psoriatic spondylarthritis, n=4; ankylosing spondylitis, n=2; enteropathic spondylarthritis, n=1), two patients with spinal osteoarthritis and two patients with rheumatoid arthritis, all with lumbar pain. Patients with spondylarthritis had active disease and were not receiving biological agents. All patients underwent magnetic resonance imaging (MRI) of the lumbar spine, while nine patients (five with PMR and four controls) also received an MRI of the thoracic spine.
Nine patients with PMR and five controls displayed evidence of interspinous lumbar bursitis. Patients with PMR experienced significantly more frequent moderate to marked (grade 2 or higher) lumbar bursitis compared with controls (60% vs. 9%; P=.02). Lumbar bursitis was found most commonly at the L3–L5 interspaces in PMR patients and controls. One PMR patient had widespread lumbar bursitis and one control patient displayed lumbar bursitis at L2–L4. MRI of the thoracic spine of PMR and control patients did not demonstrate interspinous bursitis.
The limited number of patients and lack of repeat examinations after treatment initiation were study limitations, researchers said.
“Lumbar bursitis is likely to contribute to the discomfort and pain in the lower back reported by some PMR patients,” the researchers concluded. “The prominent inflammatory involvement of cervical and lumbar bursae confirms the hypothesis that PMR is primarily a periarticular, bursal-based disorder.”
Disclosure: The researchers report no relevant financial disclosures.
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