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IMAGING AND SEROLOGICAL PROFILING OF PATIENTS WITH POLYMYALGIA RHEUMATICA AND GIANT CELL ARTERITIS
No full textBackground: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are two inflammatory conditions affecting people aged over 50 years. PMR is characterized by pain and stiffness in the shoulder and hip girdles. GCA, a large vessel vasculitis, is the most common form of primary systemic vasculitis. About 40-60% of patients with GCA present with concomitant PMR, and histologic features consistent with GCA can be detected on temporal artery biopsy of about 16% to 21% of patients with PMR. It is still debated whether PMR and GCA are different conditions or represent different clinical manifestations across the spectrum of a single disease. The aim of this research project was to profile immunological and imaging aspects of these two conditions to better characterize their similarities and differences.
Patients and methods: A cohort of unselected, consecutive patients with PMR, GCA or both was studied. PMR was diagnosed according to Bird et al. criteria, whereas patients with cranial (C)-GCA were diagnosed according to the 1990 ACR classification criteria; a subset of these patients underwent temporal artery biopsy. Five further patients with fever of unknown origin (FUO) and imaging evidence of large vessel vasculitis (LVV) were included. All patients underwent a detailed and standardized clinical examination and, subsequently, a 18F- Fluorodeoxyglucose (FDG) positron emission tomography (PET) scan.. Joint and vascular uptake were evaluated by a qualitative visual score, using the liver uptake as a reference, and with semi-quantitative mean standardized uptake value (SUV). Each value of the qualitative joint and vascular scores of every region were summed up to obtain a total joint score (TJS) and a total vascular score (TVS). In a subgroup of patients, serum samples were collected just before the injection of FDG on the same day of the PET scan. The soluble (s) immune checkpoints cytotoxic T-lymphocyte antigen-4 (CTLA-4), soluble programmed death-1 (sPD-1) and programmed death-ligand 1 and 2 (PD-L1 and PD-L2) were measured in this subgroup. The serum of fifty healthy controls were studied for comparison.
Results: One hundred and thirty-one patients underwent FDG-PET/CT scanning, including 89 females and 42 males, with a median age of 74 years (range 47-92). Ninety-seven patients were diagnosed as PMR, 13 as C-GCA, 16 with both PMR and C-GCA and five patients presented with FUO. Soluble CTLA-4, sPD1, sPD-L1, and sPD-L2, evaluated in 40 patients (32 with PMR and 8 with PMR+C-GCA), were increased in comparison with controls (p<0.001 for all the comparisons), although no statistically significant difference between patients with PMR+C-GCA and those with isolated PMR was found.
Conclusions: Patients with PMR and GCA share many immunological and imaging abnormalities. Results from this study demonstrate that available and evaluated biomarkers are unable to precisely differentiate these two conditions
[Polymyalgia rheumatica: diagnostic and therapeutic issues of an apparently straightforward disease.]
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From polymyalgia arteritica to arteritis polymyalgica: redefining the GCA-PMR spectrum through advanced MRI insights
No full textHigh frequency of capsular knee involvement in polymyalgia rheumatica/giant cell arteritis patients studied by positron emission tomography
No full textObjective. Peripheral arthritis has been described in up to 50% of PMR patients, with knee involvement in the majority. This study was designed to evaluate by PET/CT the knees of patients with PMR and GCA and to identify the knee structures involved by inflammation. Methods. Twenty-five consecutive patients with PMR (19) or GCA (6) were studied in comparison with 25 age- and sex-matched controls who underwent PET/CT for initial staging of cancer. Clinical features, ESR and CRP were evaluated. Simultaneous FDG-PET and CT imaging from the skull base to the knee was performed after injection of 4.8-5.2 MBq of [18F]FDG per kilogram body weight. The knee anatomical structures being evaluated included joints, fibrous capsule, synovial recesses and bursae. Results. At PET/CT, 21/25 patients (84%) showed bilateral diffuse uptake at the knees. The tracer clearly outlined the contour of the fibrous capsule. In 50 knees, 90% of capsular sites were involved by inflammation in comparison with 23% of intracapsular sites and 4.7% of extracapsular sites (P < 0.0001). No correlation was found between PET/CT results and ESR or CRP. FDG uptake, with a pattern similar to that observed in 96% of PMR/GCA patients, was seen in 20% of controls (P = 0.03).Conclusion. Our findings suggest that bilateral capsulitis of the knee is detectable in most PMR/GCA patients if a sensitive imaging technique such as PET/CT is used. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved
Ankylosis of the wrist bones in patients with rheumatoid arthritis: a study with extremity-dedicated MRI
No full textAbstract
Objective
Ankylosis, or spontaneous bone fusion, of the small joints of the hand is a rare event in patients with rheumatoid arthritis (RA), being observed in 0.8% of them on conventional radiographs. It is associated with long-lasting and severe disease.
In other settings, such as fracture healing, bone fusion is a reparative process.
The aim of this paper is the study of the frequency of wrist ankylosis in patients with RA in comparison with other
arthritides; to correlate ankylosis with disease activity.
Methods
A total of 94 patients affected by RA, 71 patients with different rheumatic conditions and 42 controls with no joint disease or with slight hand osteoarthritis were studied. DAS-28 CRP was calculated in patients with RA and psoriatic arthritis. MRI of the clinically most involved wrist was performed with a 0.2 T, extremity-dedicated MRI system.
Results Of RA patients, 10/94 (10.6%) showed ankylosis in comparison with 2/113 (1.8%) controls (p=0.015). RA patients with
ankylosis had longer disease duration (p=0.019) but similar disease activity.
Conclusion
MRI-defined bone ankylosis is frequent in RA. It is not limited to seronegative spondyloarthritides and may be part of the bone damage observed in RA
Clinical and FDG-PET/CT correlates in patients with polymyalgia rheumatica
No full textObjective: 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. Conclusion: 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. © Copyright Clinical and Experimental Rheumatology 2022
Interspinous bursitis is common in polymyalgia rheumatica, but is not associated with spinal pain
Full text linkPolymyalgia rheumatica (PMR) is a common inflammatory disease in older people characterized by shoulder and/or pelvic girdle, and cervical and, occasionally, lumbar pain. Interspinous bursitis has been suggested as a potential cause of spinal symptoms. We evaluated, by 18 F-fluorodeoxyglucose (FDG) positron emission tomography integrated with computed tomography (PET/CT), the vertebral structures involved in PMR in a cohort of consecutive, untreated patients
Seronegative spondyloarthropathies: what radiologists should know
No full textInflammatory involvement of the spine and sacroiliac joints is the most peculiar feature of seronegative spondyloarthropathies (SpA), which include ankylosing spondylitis, psoriatic arthritis, reactive arthritis (Reiter's syndrome), enteropathic spondylitis (related to inflammatory bowel diseases) and undifferentiated spondyloarthropathies. SAPHO syndrome may also be considered a SpA, but there is no clear agreement in this respect. Imaging, along with clinical and laboratory evaluation, is an important tool to reach a correct diagnosis and to provide a precise grading of disease progression, influencing both clinical management and therapy. Conventional radiography, which is often the first-step imaging modality in SpA, does not allow an early diagnosis. Computed tomography (CT) demonstrates with a very high spatial resolution the tiny structural alterations of cortical and spongy bone before they become evident on plain film radiographs. Magnetic resonance imaging (MRI) is the only modality that provides demonstration of bone marrow oedema, which reflects vasodilatation and inflammatory hyperaemia. The primary aim of this review article was to examine the involvement of the spine and sacroiliac joints in SpA using a multimodal radiological approach (radiography, CT, MRI), providing a practical guide for the differential diagnosis of these conditions
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