We aimed to identify predictors of inadequate response to glucocorticoid (GC) treatment in patients with polymyalgia rheumatica (PMR). We retrospectively studied 32 patients as a derivation cohort and 24 patients as a validation cohort. The patients were divided into two groups according to the response to GC treatment: GC-responders and GC-inadequate responders (GC-IRs). We compared laboratory data and bilateral shoulder ultrasound findings between the groups. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff value of candidate predictors of treatment response; the predictors were examined using multivariate logistic analysis. Gray-scale ultrasound findings of long head of the biceps (LHB) tenosynovitis and subacromial/subdeltoid (SAD) bursitis were scored semiquantitatively (0-3). A total gray-scale score (TGSS) was calculated as the sum of the gray-scale scores. In the derivation cohort, serum lactate dehydrogenase (LDH) levels and TGSS were significantly higher in GC-IRs than in GC-responders. On ROC analysis, the cutoff values of serum LDH levels ≥ 175 IU/ml and TGSS ≥ 5 were found to be the candidate predictors. Multivariate logistic analysis revealed an independent association of both the predictors with inadequate response to GC treatment. In the validation cohort, patients with one or both predictors exhibited a higher incidence of inadequate response to GC treatment. These findings indicate that the severities of LHB tenosynovitis and SAD bursitis evaluated using ultrasound and serum LDH levels are independent predictors of inadequate response to GC treatment in patients with PMR. Treatment adjustment based on prediction model may allow precise treatment of patients with PMR.

中文翻译：

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肩部超声检查和血清乳酸脱氢酶可预测风湿性多肌痛患者对糖皮质激素治疗的反应不足。

我们旨在确定风湿性多肌痛（PMR）患者对糖皮质激素（GC）治疗反应不足的预测因素。我们回顾性研究了32例患者作为派生队列，对24例患者作为验证队列。根据对GC治疗的反应将患者分为两组：GC反应者和GC反应不足者（GC-IR）。我们比较了两组之间的实验室数据和双侧肩部超声检查结果。进行受试者工作特征（ROC）分析，以确定治疗反应候选预测因子的最佳临界值；使用多元逻辑分析检查了预测变量。对半肱二头肌（LHB）腱鞘炎和肩峰下/下三角肌（SAD）滑囊炎的灰度超声检查结果进行半定量评分（0-3）。计算总灰度等级分数（TGSS）作为灰度等级分数的总和。在派生队列中，GC-IR中的血清乳酸脱氢酶（LDH）水平和TGSS显着高于GC-响应者。在ROC分析中，发现血清LDH≥175 IU / ml和TGSS≥5的临界值是候选预测指标。多元逻辑分析显示，这两个预测因素与对GC治疗的反应不足之间存在独立的关联。在验证队列中，具有一个或两个预测变量的患者对GC治疗的反应不足的发生率较高。这些发现表明，使用超声和血清LDH水平评估的LHB腱鞘炎和SAD滑囊炎的严重程度是PMR患者对GC治疗反应不足的独立预测因子。