Polymyalgia rheumatica stays a clinical diagnosis: new international recommendations limit imaging to uncertain cases

The edition in brief

Today's rheumatology edition ends on new international recommendations for imaging in polymyalgia rheumatica, developed by a 30-member task force from 12 countries under EULAR procedures. Polymyalgia remains a clinical diagnosis: imaging is not needed to confirm it when probability is high or to exclude it when low, and is most useful at intermediate probability. No modality is recommended first-line; vascular imaging is advised when giant cell arteritis is suspected, but not as routine screening, and imaging is not recommended for monitoring or prediction. In a Japanese multicentre cohort of 1,798 treatment courses in rheumatoid arthritis, upadacitinib (HR 0.33) and filgotinib (HR 0.59) were associated with lower discontinuation for ineffectiveness than tofacitinib, and their persistence held after prior IL-6 or JAK inhibitor exposure. In the British psoriatic arthritis register of 815 patients starting advanced therapy, only 24% reached minimal disease activity at 12 months, and PDE4 inhibition carried more than twice the discontinuation risk of TNF inhibitors. A 17-centre study developed an ultrasound enthesitis score for early psoriatic arthritis with specificity above 70% but sensitivity around half. The pearl covers the giant cell arteritis questions to ask in every new polymyalgia case.