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Brief Report
DOI: 10.1016/j.reumae.2018.02.010
Available online 4 June 2019
18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with polymyalgia rheumatica: Screening for vasculitis
18F-FDG PET/TC en pacientes con polimialgia reumática: despistando vasculitis
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Karla Arévalo Rualesa,
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arevalo_kar@gva.es

Corresponding author.
, Rosa Negueroles Albuixecha, José Loaiza Gongorab, Elena Grau Garcíaa, José Ivorra Cortésa, José A. Román Ivorraa
a Servicio de Reumatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
b Servicio de Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Received 02 October 2017. Accepted 07 February 2018
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Abstract
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Table 1. Clinical and analytical features of the patients.
Abstract
Objective

Polymyalgia rheumatica (PR) can be associated with large vessel vasculitis (LVV). We evaluate the diagnostic role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and its impact on the treatment of LVV associated with PR.

Materials and methods

Retrospective study of patients diagnosed with PR. Data was collected from health records. Blood analysis included acute-phase reactants (APR), C-reactive protein (CRP) and erythrocyte sedimentation rate. An 18F-FDG PET/CT scan was performed in those patients whose symptoms persisted, in those with elevated APR, those who required higher doses of steroids or those who had atypical features of PR (low-grade fever, weight loss, among others).

Results

Twenty-three were eligible; 48% (n=11) of the patients were diagnosed with LVV associated with PR. The site was heterogeneous, but mostly involved the aorta. In 80% of the patients with LVV, a disease-modifying antirheumatic drug was added to their treatment. Elevated CRP values were associated with the likelihood of presenting LVV.

Conclusions

LVV is not uncommon, clinical features and elevated CRP levels should raise suspicion of LVV associated with PR. 18F-FDG PET/CT is useful in identifying LVV associated with PR.

Keywords:
Polymyalgia rheumatica
Vasculitis
Positron emission tomography–computed tomography
Resumen
Objetivo

La polimialgia reumática (PMR) puede asociarse a vasculitis de grandes vasos (VGV). Este trabajo pretende evaluar el papel de 18F-FDG PET/TC en el diagnóstico de VGV asociado a PMR.

Materiales y método

Estudio retrospectivo de pacientes con PMR. Se recogieron datos clínicos, analíticos, reactantes de fase aguda (RFA) (PCR, VSG), y a quienes tenían clínica persistente, elevación de RFA, precisaban dosis elevadas de corticoterapia o cuadros atípicos de PMR (febrícula, pérdida de peso, etc.) se realizó 18F-FDG PET/TC.

Resultados

Veintitrés pacientes se incluyeron; el 48% (11) de los cuales tuvieron VGV asociada a PMR. La localización fue heterogénea pero en su mayoría involucró a la aorta. En cuanto al tratamiento, se añadieron fármacos modificadores de la enfermedad a más del 80% de los pacientes con VGV. Los pacientes con VGV tenían niveles de PCR elevados comparado con aquellos con PMR aislada.

Conclusiones

La VGV en PMR no es infrecuente, tanto la clínica como los valores de PCR elevados deben hacer sospechar la posibilidad de VGV asociada. El estudio de imagen 18F-FDG PET/TC es una herramienta útil identificando VGV asociada a PMR.

Palabras clave:
Polimialgia reumática
Vasculitis
Tomografía por emisión de positrones–tomografía computarizada

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