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Clinical and FDG-PET/CT correlates in patients with polymyalgia rheumatica
Dario Camellino1, Francesco Paparo2, Silvia D Morbelli3
1Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Arenzano, and Autoimmunology Laboratory, Department of Internal Medicine, University of Genova, Italy.
Objectives:
We aimed to evaluate joint and vessel uptake in patients with polymyalgia rheumatica (PMR) by FDG-PET and correlate it with clinical findings.
Methods:
Consecutive PMR patients, without clinical signs of giant cell arteritis, underwent a standardised clinical examination and FDG-PET/CT. Controls were consecutive subjects undergoing FDG-PET for the suspicion of neoplasm not confirmed by the examination. Uptake was evaluated by a qualitative visual score, using the liver uptake as reference and by the semi-quantitative mean standardised uptake value (SUV) and target-to-background ratio (TBR) methods.
Results:
Eighty-four patients and 84 controls (55 women, median age 73 years, range 50-92 years in both groups) were studied. Sixteen patients were taking glucocorticoids (GC). PMR patients showed a higher articular uptake than controls. GC-treated patients showed uptake lower than GC-naïve patients, but still higher than controls. PMR patients showed a higher vascular uptake than controls in all districts except in the carotid arteries, when evaluated by the visual score. Conversely, the semi-quantitative approach yielded no significant differences. Forty-two patients (50%) showed PET evidence of large-vessel vasculitis (LVV), defined as uptake ≥ than that of the liver, and 11.9% showed LVV with vascular uptake higher than that of the liver. The correlation between clinical findings and uptake was scarce. Neither clinical nor laboratory findings could predict the presence of LVV.
Conclusions:
Patients with PMR show a typical joint pattern at FDG-PET. There are no clinical or laboratory predictors of LVV. Imaging appears to be the only tool to assess LVV in these patients.
Insights
Fluorodeoxyglucose-positron emission tomography (FDG-PET) reveals typical joint uptake in polymyalgia rheumatica (PMR) patients. Imaging is crucial for detecting large-vessel vasculitis (LVV) as clinical factors do not predict its presence.
Area of Science:
- Nuclear medicine
- Rheumatology
- Vascular imaging
Background:
- Polymyalgia rheumatica (PMR) is an inflammatory condition affecting joints and potentially large vessels.
- Distinguishing PMR with large-vessel vasculitis (LVV) from PMR without LVV can be challenging using clinical assessments alone.
Purpose of the Study:
- To evaluate joint and vessel uptake in PMR patients using FDG-PET/CT.
- To correlate FDG-PET/CT findings with clinical and laboratory data.
- To determine the utility of FDG-PET/CT in identifying LVV in PMR patients.
Main Methods:
- A standardized clinical examination and FDG-PET/CT were performed on consecutive PMR patients and controls.
- Uptake was assessed using a qualitative visual score and semi-quantitative methods (SUV, TBR).
- Patients were categorized based on clinical presentation and FDG-PET/CT findings, including the presence of LVV.
Main Results:
- PMR patients demonstrated higher articular uptake compared to controls.
- Vascular uptake was increased in PMR patients across most arterial territories, particularly when assessed visually.
- Fifty percent of PMR patients showed PET evidence of LVV (uptake ≥ liver uptake).
- Clinical and laboratory findings showed a weak correlation with FDG-PET/CT uptake and could not predict LVV.
Conclusions:
- FDG-PET/CT shows a characteristic joint uptake pattern in PMR.
- LVV is frequently present in PMR patients, often undetected by clinical evaluation.
- FDG-PET/CT is a valuable imaging tool for assessing LVV in PMR, as clinical and laboratory predictors are lacking.
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