Le Madec Arthur, Querellou Solene, Binard Aymeric, Saraux Alain, Quere Baptiste, Marhadour Thierry, Jousse-Joulin Sandrine, Tison Alice, Cornec Divi, Guellec Dewi, Devauchelle-Pensec Valérie
Rheumatology Department, Brest University Hospital, Brest, France.
Nuclear Medicine Department, Brest University Hospital, Brest, France; University of Western Brittany (UBO), Brest, France; Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest cedex, France.
Joint Bone Spine. 2025 Jul 22;93(1):105950. doi: 10.1016/j.jbspin.2025.105950.
To assess the prevalence of giant cell arteritis (GCA) or cancer detected via 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) in patients with polymyalgia rheumatica (PMR) without clinical signs suggestive of GCA.
This monocentric retrospective cohort study analyzed PET-CT scans performed for clinical suspicion of PMR since 2018. Patients meeting the 2012 ACR/EULAR criteria for PMR without clinical indications of GCA or cancer were included. Observations were divided into two groups: new-onset PMR and treatment failure. A nuclear medicine physician evaluated qualitative liver uptake scores at articular/periarticular sites and large vessels typically involved in PMR. Increased 18F-FDG uptake suggesting cancer was also assessed.
Of 1223 PET-CT scans screened, 94 met the inclusion criteria: 38 for new-onset PMR and 56 for treatment failure. Subclinical GCA was identified in 10 (10.6%) patients, with a prevalence of 5.3% in the new-onset group and 14.2% in the treatment failure group. Aortic uptake was present in 90% of subclinical GCA cases. Sites with increased 18F-FDG uptake included hips (90%), shoulders, lumbar interspinous bursa (80%), and ischial tuberosity (60%). PET-CT identified eight (8.5%) cancer cases, equally distributed between the two groups.
PET-CT detects subclinical GCA in approximately 10% of PMR patients without suggestive symptoms, three times more frequently in the treatment failure group. Aortitis is present in 90% of subclinical GCA cases. Cancer prevalence is 4.7%, with a heterogeneous spectrum and unclear association with PMR symptoms.
评估在无巨细胞动脉炎（GCA）临床体征的风湿性多肌痛（PMR）患者中，通过18F-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（PET-CT）检测到的GCA或癌症的患病率。
这项单中心回顾性队列研究分析了自2018年以来因临床怀疑PMR而进行的PET-CT扫描。纳入符合2012年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）PMR标准且无GCA或癌症临床指征的患者。观察分为两组：新发PMR和治疗失败。一名核医学医师评估关节/关节周围部位以及PMR中通常受累的大血管处的肝脏定性摄取分数。还评估了提示癌症的18F-FDG摄取增加情况。
在筛查的1223例PET-CT扫描中，94例符合纳入标准：38例为新发PMR，56例为治疗失败。10例（10.6%）患者被诊断为亚临床GCA，在新发组中的患病率为5.3%，在治疗失败组中的患病率为14.2%。90%的亚临床GCA病例存在主动脉摄取。18F-FDG摄取增加的部位包括髋部（90%）、肩部、腰椎棘突间滑囊（80%）和坐骨结节（60%）。PET-CT发现8例（8.5%）癌症病例，两组分布均匀。
PET-CT在约10%无提示症状的PMR患者中检测到亚临床GCA，在治疗失败组中的检出频率是新发组的三倍。90%的亚临床GCA病例存在主动脉炎。癌症患病率为4.7%，谱系异质性且与PMR症状的关联尚不清楚。
