Predictors of positive 18F-FDG PET/CT-scan for large vessel vasculitis in patients with persistent polymyalgia rheumatica

Prieto-Peña, D.; Martínez-Rodríguez, I.; Loricera, J.; Banzo, Ignacio; Calderón-Goercke, Monica; Calvo-Río, V.; González-Vela, Carmen; Corrales, Alfonso; Castañeda, Santos; Blanco, Ricardo; Hernández, José L.; González-Gay, Miguel Á.

doi:10.1016/j.semarthrit.2018.05.007

Cited by 84 publications

(57 citation statements)

References 37 publications

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“…8 In recent years, the advent of new imaging techniques has revealed that GCA can also affect extracranial large vessels, even in the absence of classic cranial GCA symptoms. 13 GCA patients with predominant extracranial large vessel affection are usually younger at diagnosis and present more commonly with refractory features of PMR, fever of unknown origin, constitutional symptoms, and/or limb claudication. [14][15][16] Cutaneous manifestations are uncommon in GCA and are rarely found as the presenting symptom of GCA.…”

Section: Introductionmentioning

confidence: 99%

A Review of the Dermatological Complications of Giant Cell Arteritis

Prieto-Peña¹,

Castañeda²,

Atienza‐Mateo³

et al. 2021

CCID

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Giant cell arteritis (GCA) is characterized by granulomatous inflammation of large and medium-sized vessels. It is the most common vasculitis among elderly people in Europe and North America. GCA usually presents with ischemic cranial manifestations such as headache, scalp tenderness, visual manifestations, and claudication of the tongue and jaw. Thickness and tenderness of temporal arteries are the most recognizable signs of GCA on physical examination. Laboratory tests usually show raised acute phase reactants. Skin manifestations are uncommon in GCA and are rarely found as a presenting symptom of GCA. Necrosis of the scalp and tongue is the most common ischemic cutaneous manifestation of GCA. Although infrequent, when present it reflects severe affection and poor prognosis of GCA. Panniculitis-like lesions have been reported in the setting of GCA, with nodules being the most common finding. Other entities, such as generalized granuloma annulare or basal cell carcinoma have been occasionally described in GCA patients. Prompt recognition and initiation of therapy are crucial to prevent serious complications of GCA. When high suspicion of GCA exists, immediate administration of glucocorticoids is recommended. It is advisable to refer the patient to a specialist GCA team for further multidisciplinary assessment.

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Section: Introductionmentioning

confidence: 99%

A Review of the Dermatological Complications of Giant Cell Arteritis

Prieto-Peña¹,

Castañeda²,

Atienza‐Mateo³

et al. 2021

CCID

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“…Persistently elevated levels of CRP and IL-6 during follow-up have been associated with an increased risk of relapse and recurrence (that is, flare of PMR after discontinuation of glucocorticoid treatment) 47 . Whether some of these patients had underlying GCA is unknown; however, imaging studies reported a high prevalence of underlying LVV in patients with PMR with recurrent flares 114,115 . Surprisingly, patients with PMR who had subclinical LVV according to PET at baseline responded equally well to 15 mg daily prednisone and had a similar frequency of relapses to patients without vascular FDG uptake 103 .…”

Section: Long-term Management Predictors Of Disease Coursementioning

confidence: 99%

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

et al. 2020

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Giant cell arteritis (GCA) is the most common type of primary vasculitis in Western countries 1,2. Polymyalgia rheumatica (PMR) is the second most common inflammatory rheumatic disease of the elderly after rheumatoid arthritis (RA) 3. The two diseases are interrelated: 40-60% of patients with GCA have symptoms of PMR 3 , and histological features consistent with GCA have been found in 16-21% of temporal artery biopsy samples from patients with PMR 3. Most of these patients with PMR, however, presented with additional features of GCA, whereas the prevalence of positive histology in unselected patients with PMR is unknown. Both GCA and PMR are heterogeneous diseases. Although systemic manifestations (such as fever, malaise and weight loss) are common in both diseases, they are not present in all patients 4-6. Up to 1 in 5 patients with GCA with ocular involvement can present without systemic manifestations of the disease 7. GCA is the most common form of large-vessel vasculitis (LVV) and has a broad spectrum of disease manifestations, which are frequently overlapping. In the majority of cases, cranial and extracranial large arteries are involved to varying degrees, leading to different clinical phenotypes 8,9. Isolated cranial or extracranial GCA, which are at either end of this continuum, are relatively uncommon 10. Predominant cranial GCA is characterized by headache, jaw claudication and visual manifestations (representing the prototypical clinical picture of temporal arteritis). By contrast, predominant large-vessel GCA is characterized by more pronounced systemic manifestations, PMR, vascular bruits, limb claudication and imaging signs of inflammation in the aorta and its major branches 10. In some of these patients, vascular stenoses or aneurysms in association with other GCA features are the presenting clinical manifestations 9,11. PMR is characterized by pain and stiffness in the shoulder and pelvic girdles, which can have an abrupt or a subtle onset 3. Up to 20% of patients with PMR can present with a normal erythrocyte sedimentation rate (ESR) 12 , although the presence of both normal ESR and C-reactive protein (CRP) levels is rare 13-15. Glucocorticoids are the cornerstone of treatment for GCA and PMR. They are effective, but glucocorticoidrelated adverse effects occur in up to 85% of patients with GCA and 65% of patients with PMR, respectively 16-22. The IL-6 receptor inhibitor tocilizumab has become available as a glucocorticoid-sparing strategy in patients with GCA 23,24 , an approach that is also being evaluated for PMR 25,26. Management of both GCA and PMR is hampered by the lack of universally accepted definitions of remission and other disease states (such as low disease activity or vessel damage without active disease). Many questions about monitoring and long-term management are still unanswered (Box 1).

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“…A recent study showed that many patients thought to have isolated polymyalgia rheumatica, without associated cranial symptoms, often have evidence of LVV on FDG-PET. [50] These studies indicate that PET has good sensitivity for detecting vascular inflammation, but its imperfect specificity highlights that vascular PET activity may be present in other conditions, particularly atherosclerosis, and can be similar to LVV on imaging. Other limitations to PET include cost, radiation exposure, limitations to access, and lack of a standardized approach for analysis of vascular activity.…”

Section: Suspected Tak or Gca With Predominantly Large-artery Involvementmentioning

confidence: 98%

The Role of Vascular Imaging to Advance Clinical Care and Research in Large-Vessel Vasculitis

Quinn

Grayson

2019

Curr Treat Options in Rheum

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Purpose of the Review: The two main forms of large-vessel vasculitis (LVV) are giant cell arteritis (GCA) and Takayasu's arteritis (TAK). Vascular imaging can characterize disease activity and disease extent in LVV. This review critically analyzes the clinical utility of vascular imaging in LVV and highlights how imaging may be incorporated into the management and study of these conditions.Recent Findings: There are multiple imaging modalities available to assess LVV including ultrasonography, CT angiography (CTA), magnetic resonance angiography (MRA), and 18 Ffluorodeoxyglucose (FDG) positron emission tomography (PET). As these techniques are refined, imaging may be increasingly useful to evaluate the cranial arteries and the aorta and its primary branches. In addition, vascular imaging may be useful to monitor disease activity and may have prognostic value to predict future clinical events.Summary: There are strengths and weaknesses associated with vascular imaging that should be considered when evaluating patients with LVV. Vascular imaging will likely play an increasingly important role in the clinical management of patients and the conduct of research in LVV and may ultimately be incorporated as outcome measures in clinical trials in these conditions.

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Predictors of positive 18F-FDG PET/CT-scan for large vessel vasculitis in patients with persistent polymyalgia rheumatica

Abstract: Inflammatory low back pain, pelvic girdle and diffuse lower limb pain are predictors of positive PET/CT scan for LVV in PMR.

Cited by 84 publications

References 37 publications

A Review of the Dermatological Complications of Giant Cell Arteritis

A Review of the Dermatological Complications of Giant Cell Arteritis

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

The Role of Vascular Imaging to Advance Clinical Care and Research in Large-Vessel Vasculitis

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