Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
Nuclear Medicine Division, Hospital Universitario Marqués de Valdecilla, Molecular Imaging Group, IDIVAL, Santander, Spain.
Semin Arthritis Rheum. 2019 Feb;48(4):720-727. doi: 10.1016/j.semarthrit.2018.05.007. Epub 2018 May 18.
Polymyalgia rheumatica (PMR) is often the presenting manifestation of giant cell arteritis (GCA). Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan often discloses the presence of large vessel vasculitis (LVV) in PMR patients. We aimed to identify predictive factors of a positive PET/CT scan for LVV in patients classified as having isolated PMR according to well-established criteria.
A set of consecutive patients with PMR from a single hospital were assessed. All of them underwent PET/CT scan between January 2010 and February 2018 based on clinical considerations. Patients with PMR associated to other diseases, including those with cranial features of GCA, were excluded. The remaining patients were categorized in classic PMR (if fulfilled the 2012 EULAR/ACR classification criteria at disease diagnosis; n = 84) or atypical PMR (who did not fulfill these criteria; n = 16). Only information on patients with classic PMR was assessed.
The mean age of the 84 patients (51 women) with classic PMR was 71.4 ± 9.2 years. A PET/CT scan was positive in 51 (60.7%). Persistence of classic PMR symptoms was the most common reason to perform a PET/CT scan. Nevertheless, patients with positive PET/CT scan often had unusual symptoms. The best set of predictors of a positive PET/CT scan were bilateral diffuse lower limb pain (OR = 8.8, 95% CI: 1.7-46.3; p = 0.01), pelvic girdle pain (OR = 4.9, 95% CI: 1.50-16.53; p = 0.01) and inflammatory low back pain (OR = 4.7, 95% CI: 1.03-21.5; p = 0.04).
Inflammatory low back pain, pelvic girdle and diffuse lower limb pain are predictors of positive PET/CT scan for LVV in PMR.
巨细胞动脉炎（GCA）常为多发性肌炎（PMR）的首发表现。氟-18-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）扫描常显示 PMR 患者存在大血管血管炎（LVV）。我们旨在确定根据既定标准分类为孤立性 PMR 的患者中，PET/CT 扫描对 LVV 阳性的预测因素。
对来自一家医院的一组连续 PMR 患者进行评估。所有患者均于 2010 年 1 月至 2018 年 2 月根据临床考虑进行 PET/CT 扫描。排除 PMR 合并其他疾病的患者，包括有 GCA 颅面特征的患者。其余患者分为经典 PMR（若在疾病诊断时符合 2012 年 EULAR/ACR 分类标准；n=84）或非典型 PMR（不符合这些标准；n=16）。仅评估符合经典 PMR 的患者信息。
84 例（51 名女性）经典 PMR 患者的平均年龄为 71.4±9.2 岁。51 例（60.7%）PET/CT 扫描阳性。持续性经典 PMR 症状是进行 PET/CT 扫描的最常见原因。然而，PET/CT 扫描阳性的患者常有不寻常的症状。预测 PET/CT 扫描阳性的最佳因素是双侧弥漫性下肢疼痛（OR=8.8，95%CI：1.7-46.3；p=0.01）、骨盆带疼痛（OR=4.9，95%CI：1.50-16.53；p=0.01）和炎症性腰痛（OR=4.7，95%CI：1.03-21.5；p=0.04）。
炎症性腰痛、骨盆带和弥漫性下肢疼痛是 PMR 患者 PET/CT 扫描 LVV 阳性的预测因素。
