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Published on: August 8, 2019
Repetitive 18-fluorodeoxyglucose positron emission tomography in isolated polymyalgia rheumatica: a prospective study
D Blockmans1, L De Ceuninck, S Vanderschueren
1MD, PhD, Department of General Internal Medicine, University Hospital Leuven, Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. Daniel.Blockmans@uz.kuleuven.ac.be
Objective:
To study fluorodeoxyglucose (FDG) deposition in different vascular beds and in the large joints of patients with isolated polymyalgia rheumatica (PMR), and to investigate whether there is a relation between FDG-positron emission tomography (PET) results and risk of relapse.
Methods:
All consecutive patients with isolated PMR underwent a FDG-PET scan before treatment with steroids was started and--if logistics allowed--at 3 and 6 months. PET scans were scored at seven different vascular areas and a total vascular score (TVS) was calculated, ranging from 0 to 21. FDG uptake in the shoulders, the hips and the processi spinosi of the vertebrae was scored as 0 (no uptake), 1 (moderate uptake) or 2 (intense uptake).
Results:
Thirty-five patients entered the study. At diagnosis, vascular FDG uptake was noted in 11 patients (31%), predominantly at the subclavian arteries. Mean TVS was low. FDG uptake in the shoulders was noted in 94% of patients, in the hips in 89% and in the processi spinosi of the vertebrae in 51%. The intensity of FDG uptake in the large vessels or in the shoulders, hips or processi spinosi did not correlate with the risk of relapse.
Conclusions:
Only one in three patients has an (moderately) increased vascular FDG uptake, especially in the subclavian arteries. The vast majority has inflammation of shoulders and hips, and half of them have increased FDG-uptake at the processi spinosi. Results of FDG-PET scans in patients with PMR did not correlate with their risk of relapse.
Insights
Fluorodeoxyglucose-positron emission tomography (FDG-PET) scans show vascular inflammation in only one-third of polymyalgia rheumatica (PMR) patients, and joint inflammation is common. FDG-PET results did not predict relapse risk in PMR.
Area of Science:
- Nuclear Medicine
- Rheumatology
- Vascular Medicine
Background:
- Polymyalgia rheumatica (PMR) is an inflammatory condition affecting large joints.
- The role of vascular inflammation in PMR and its correlation with relapse risk requires further investigation.
Purpose of the Study:
- To assess fluorodeoxyglucose (FDG) deposition in vascular beds and large joints of PMR patients.
- To determine if FDG-positron emission tomography (PET) findings correlate with the risk of PMR relapse.
Main Methods:
- Consecutive patients with isolated PMR underwent FDG-PET scans before steroid treatment.
- Scans were evaluated for FDG uptake in seven vascular areas and large joints (shoulders, hips, vertebrae).
- A total vascular score (TVS) was calculated, and joint uptake was graded.
Main Results:
- Vascular FDG uptake was observed in 31% of patients at diagnosis, primarily in subclavian arteries.
- FDG uptake was prevalent in shoulders (94%), hips (89%), and vertebral processi spinosi (51%).
- Neither vascular nor joint FDG uptake intensity correlated with relapse risk.
Conclusions:
- A minority of PMR patients exhibit significant vascular FDG uptake, mainly in the subclavian arteries.
- The majority of PMR patients show joint inflammation on FDG-PET scans.
- FDG-PET findings in PMR do not appear to predict the risk of disease relapse.
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