Zdenek Rehak1,2, Jiri Vasina1,3, Petr Nemec4, Zdenek Fojtik5, Renata Koukalova1, Zbynek Bortlicek6, Dorota Rehakova7, Jan Adam2,8, Alena Vavrusova9, Zdenek Adam5. 1. Department of Nuclear Medicine and PET Center, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic. 2. Regional Center of Applied Molecular Oncology (RECAMO), Masaryk Memorial Cancer Institute Brno. 3. Center of Molecular Imaging, International Clinical Research Center (ICRC), St. Anne's University Hospital in Brno. 4. Rheumatology Unit, 2nd Department of Internal Medicine, St. Anne´s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno. 5. Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno. 6. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno. 7. Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno. 8. Radiopharmaceuticals Division, UJV Rez, a. s., Rez. 9. Department of Internal Medicine, Hospital Trebic Corresponding author: Zdenek Rehak, e-mail:
Abstract
AIM: Polymyalgia rheumatica (PMR) is a disease presenting with pain and stiffness, mainly in shoulders, hip joints and neck. Laboratory markers of inflammation may bolster diagnosis. PMR afflicts patients over 50 years old, predominantly women, and may also accompany giant cell arteritis. PATIENTS AND METHODS: 67 patients, who fullfiled Healey´s criteria for PMR in the period between 2004 and 2013 and had positive FDG PET (PET/CT) findings were retrospectively evaluated. FDG uptake was assessed in large arteries, proximal joints (shoulders, hips and sternoclavicular joints), in extraarticular synovial structures (interspinous, ischiogluteal and praepubic bursae). RESULTS: Articular/periarticular involvement (A) was detected in 59/67 (88.1%) patients and extrarticular synovial involvement (E) in 51/67 (76.1%) patients either individually or in combinations. Vascular involvement (V) was detected in 27/67 (40.3%) patients only in combination with articular (A) and/or extraarticular synovial (E) involvement. These combinations were: A+E involvement in 30/67 (44.8%) patients, A+V involvement in 8/67 (11.9%) patients, E+V involvement in 6/67 (9%) patients and A+E+V in 13/67 (19.4%) patients. CONCLUSIONS: PMR presents by articular/periarticular synovitis, extraarticular synovitis and can be accompanied by giant cell arteritis. All types of involvement have their distinct FDG PET (PET/CT) finding, which can be seen either individually or in any of their 4 combinations. FDG PET (PET/CT) examination seems to be an advantageous one-step examination for detecting different variants of PMR, for assessing extent and severity and also for excluding occult malignancy.
AIM: Polymyalgia rheumatica (PMR) is a disease presenting with pain and stiffness, mainly in shoulders, hip joints and neck. Laboratory markers of inflammation may bolster diagnosis. PMR afflicts patients over 50 years old, predominantly women, and may also accompany giant cell arteritis. PATIENTS AND METHODS: 67 patients, who fullfiled Healey´s criteria for PMR in the period between 2004 and 2013 and had positive FDG PET (PET/CT) findings were retrospectively evaluated. FDG uptake was assessed in large arteries, proximal joints (shoulders, hips and sternoclavicular joints), in extraarticular synovial structures (interspinous, ischiogluteal and praepubic bursae). RESULTS: Articular/periarticular involvement (A) was detected in 59/67 (88.1%) patients and extrarticular synovial involvement (E) in 51/67 (76.1%) patients either individually or in combinations. Vascular involvement (V) was detected in 27/67 (40.3%) patients only in combination with articular (A) and/or extraarticular synovial (E) involvement. These combinations were: A+E involvement in 30/67 (44.8%) patients, A+V involvement in 8/67 (11.9%) patients, E+V involvement in 6/67 (9%) patients and A+E+V in 13/67 (19.4%) patients. CONCLUSIONS: PMR presents by articular/periarticular synovitis, extraarticular synovitis and can be accompanied by giant cell arteritis. All types of involvement have their distinct FDG PET (PET/CT) finding, which can be seen either individually or in any of their 4 combinations. FDG PET (PET/CT) examination seems to be an advantageous one-step examination for detecting different variants of PMR, for assessing extent and severity and also for excluding occult malignancy.
Authors: Christian Dejaco; Elisabeth Brouwer; Justin C Mason; Frank Buttgereit; Eric L Matteson; Bhaskar Dasgupta Journal: Nat Rev Rheumatol Date: 2017-09-14 Impact factor: 20.543