Background/Purpose:
Purpose: To assess the value of 18-Fludeoxyglucose Positron Emission Tomography (PET) in patients with primary Sjogren’s Syndrome (pSS).
Methods:
All patients with confirmed pSS (AECG) from 3 French university centers who underwent PET were retrospectively analysed. PET was realized to assess activity in SS-related interstitial lung disease (ILD) (n=24), lymphoma suspicion (n=10) or systematically (n=5). Positive PET was defined as FDG uptake >2.5 SUVmax. A control group was constituted of patients with PET for isolated pulmonary nodule (n=17).
Results:
Thirty-nine patients with pSS were included (table 1). FDG uptake was noted in 30 cases (83%): salivary gland (n=20 (57%); median SUVmax 3.1 [2,8-4]); lymph nodes (n=24 (67%); median SUVmax 5 [4-8]); pulmonary uptake (n=13 (33%); median SUVmax 3,3 [3-6]) and thyroiditis (n=3). Salivary gland uptake was more frequent and SUVmax was higher in pSS than in the control group (median 3 [2,8-4] versus 2 [1,5-2,5]; p<0,001).
In 24 patients with ILD, 13 (57%) had FDG pulmonary uptake (median SUVmax 3 [3-6]). Whereas there were no clinical, biological or functional respiratory test difference between ILD patients with/without FDG uptake, patients with pulmonary FDG uptake had also more lymph node uptake, and PET allowed the diagnosis of active ILD in these patients, with 100% specificity.
In 10 patients with PET for suspected lymphoma, PET confirmed diagnosis in 6 cases, and confirmed the remission in 1 case.
Lymph node FDG uptake was present in 24 (67%) cases and was significantly associated with pulmonary uptake in ILD patients. With a follow up of 2 years [0,8-4], no patient with lymph node FDG uptake developed lymphoma.
Conclusion:
Whereas salivary uptake is frequent in pSS, in patients with ILD, PET could constitute an interesting tool to assess activity, and necessitate to be confirmed in prospective study.
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All patients N=39
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PET to exclude lymphoma N= 15
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PET to assess activity in patients with ILD N= 24
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Clinical data
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Age (years)
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54 [47-67]
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54 [46-67]
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54 [49-64]
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Sex (males)
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8 (22%)
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4 (26,6%)
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4 (16%)
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Asthenia
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38 (98%)
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14 (93%)
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24 (100%)
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Subjective Xerophtalmia
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35 (90%
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14 (93%)
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21 (88%)
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Subjective Xerostomia
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36 (92%)
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15 (100%)
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21 (88)
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Glandular hypertrophy
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8 (21%)
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5 (33,%)
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3 (13%)
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Objective xerophtalmia
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14 (56%)
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8 (54%)
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7 (29%)
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Objective xerostomia
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18 (70%)
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7 (47%)
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11 (46)
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ESSDAI score
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21 [10-24]
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10 [7-13]
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24 [21-28]*
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Organ involvement (n; %)
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Skin
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16 (41%)
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4 (27%)
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12 (50%)
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Neurological
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8 (21%)
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5 (33%)
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3 (13%)
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Joint
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18 (46%)
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5 (33%)
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13 (54%)
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Pulmonary
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24 (62%)
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–
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–
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Lymphoma
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7 (18%)
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2 (13%)
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5 (21%)
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Laboratory data (median IQR25-75)
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ESR
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24 [12-49]
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13 [10-23]
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54 [33-80]*
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C-reactive protein (g/l)
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9[4-22]
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4[3-5]
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17 [7-33]**
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Gammaglobulins (g/l)
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12 [8-27]
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11 [8-15]
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16 [10-29]
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Hg (g/dl)
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12,5[11-13]
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12,75 [11,75-13,75]
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12,2 [11-13,1]
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Platelets (G/L)
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250 [183-293]
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246 [189-250]
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250 [178-320]
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Lymphocytes (n/mm3)
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1550 [1160-1992]
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1300 [900-1500]
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1830 [1350-2000]
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Cryoglobulinemia
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4 (10%)
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1 (0,06%)
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3 (13%)
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Treatments
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Corticosteroids
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16 (41%)
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4 (26%)
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12 (50%)
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Corticosteroids dose (mg/day)
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10 [10-15]
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10 [10-10]
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10 [10-15]
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Hydroxychloroquine
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17 (44%)
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5 (33%)
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12 (50%)
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PET results
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Pulmonary uptake
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13 (33,3%)
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0
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13 (57%)*
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Lung SUVmax
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3,3 [3-6]
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0
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3,3 [3-6]
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Lymph node fixation
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24 (67%)
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7 (50%)
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18 (75%)
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Lymph node SUVmax
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5 [4-8]
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3,8 [3-4]
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5,4 [4-8]
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Salivary gland fixation
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20 (57%)
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10 (71%)
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11 (48%)
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Salivary gland SUVmax
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3,1 [2,8-4]
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2,7 [2,7 -3]
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3 [2,7-4]
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*p<0,005
** p =0,006
Disclosure:
C. Cohen,
None;
A. Mekinian,
None;
M. Soussan,
None;
Y. Uzunhan,
None;
V. Eder,
None;
R. Dhote,
None;
D. Valeyre,
None;
O. Fain,
None.
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