Session Information
Date: Sunday, October 21, 2018
Title: Vasculitis Poster I: Non-ANCA-Associated and Related Disorders
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease of the elderly whose diagnosis is usually based on clinical, analytical and ultrasound findings. However, sometimes patients who present symptoms resembling PMR do not complete fulfill the 2012 EULAR/ACR criteria. It is not well known if these atypical patients behave as those who fulfill criteria. In these cases, Positron Emission Tomography/computed tomography (PET/CT) could be a useful tool to assess if these patients have a similar pattern of 18F-FDG uptake to those who fulfill criteria.
Objectives:
Our aims were: a) to compare clinical and analytical features in patients with classic PMR to atypical PMR, b) to asses if findings in PET/CT differ between both groups.
Methods:
Retrospective study of 93 patients with PMR and their respective PET/CT scans from a single University referral center. We considered two groups: a) Classic PMR: patients who fulfilled the 2012 EULAR/ACR criteria; and b) Atypical PMR: patients with symptoms resembling classic PMR but did not fulfill the 2012 EULAR/ACR criteria.
Results:
We evaluated 93 patients (30 men/63 women) with a mean age±SD of 69.2±10.8 years. A PET/CT was performed in all of them. Eighty (86%) patients had classic PMR and 13 (14%) atypical PMR. The comparative study is shown in the TABLE. Both groups were receiving similar doses of Prednisone at the time of PET/CT performance. Patients with atypical PMR were younger and had shorter duration of symptoms. Pain in the pelvic girdle was more frequent in patients with atypical PMR (100% vs 65%) while shoulder girdle pain was higher in patients with classic PMR (23.1% vs 72.5%). No significant differences were found in PET/CT findings between classic and atypical PMR, although large vessel involvement was slightly more frequent in patients with atypical PMR.
Conclusion:
Patients with atypical PMR used to be younger with a shorter evolution of symptoms and had predominantly pelvic girdle affection. Despite these differences, the pattern of F-FDG uptake in PET/TC was similar in classic and atypical PMR.
TABLE
|
|
Classic PMR (n=80) |
Atypical PMR (n=13) |
P |
|
Sex (women), n (%) |
55 (68.8) |
8 (61.5) |
0.61 |
|
Age (years), mean ± SD |
70.9±9.8 |
58.3±10 |
< 0.01 |
|
Duration of symptoms (months), median [IQR] |
13.0 [6.0-38.0] |
6.0[4.0-11.0] |
< 0.01 |
|
Clinical symptoms, n (%) * |
|
|
|
|
Neck pain |
16 (20.0) |
2 (15.4) |
0.63 |
|
Shoulder girdle pain |
58 (72.5) |
3 (23.1) |
0.02 |
|
Pelvic girdle pain |
52 (65.0) |
13 (100) |
0.03 |
|
Morning stiffness |
19 (23.8) |
4 (30.8) |
0.68 |
|
Inflammatory low back pain |
15 (18.8) |
3 (23.1) |
0.79 |
|
Diffuse lower limb pain |
27 (33.8) |
3 (23.1) |
0.51 |
|
Laboratory markers, * |
|
|
|
|
Hb (g/dL), mean ± SD |
12.7 ± 1.4 |
12.3 ± 1.6 |
0.14 |
|
Platelet count (x109/l), mean ± SD |
280 ±-85.3 |
276 ±99.5 |
0.19 |
|
CRP (mg/dL), median [IQR] |
0.9[0.6-1.3] |
0.7 [0.3-1.5] |
0.31 |
|
ESR (mm/1 st h), median [IQR] |
35 [12.0-65.1] |
30 [15.7-58.8] |
0.21 |
|
F-FDG uptake, n (%) |
|||
|
Cervical interspinous bursae |
10 (12.5) |
1 (7.7) |
0.62 |
|
Shoulders |
47 (58.8) |
5 (38.5) |
0.21 |
|
Sternoclavicular joints |
34 (42.5) |
6 (46.2) |
0.81 |
|
Hips |
36 (45.0) |
6 (46.2) |
0.98 |
|
Lumbar interspinous bursae |
29 (36.2) |
5 (38.5) |
0.88 |
|
Pubic symphysis |
2 (2.5) |
2 (15.4) |
0.09 |
|
Subtrochanteric bursae |
20 (25.0) |
2 (15.4) |
0.45 |
|
Ischial tuberosities |
22 (27.5) |
2 (15.4) |
0.36 |
|
Knees |
37 (46.2) |
6 (46.2) |
0.99 |
|
Large vessel involvement |
49 (61.3) |
10 (76.9) |
0.27 |
|
Corticosteroids therapy |
|
|
|
|
Dose of Prednisone (mg), mean |
10.0 [5.0-15.0] |
10.0 [8.1-15.0] |
0.99 |
*At the time of PET/TC performance
To cite this abstract in AMA style:
Prieto Peña D, Calderón Goercke M, Loricera J, Martínez-Rodríguez I, Banzo I, Atienza-Mateo B, Martín-Varillas JL, Calvo-Río V, Gonzalez Vela C, González-Gay MA, Hernández JL, Blanco R. Classic and Atypical Polymyalgia Rheumatica, Are Different Syndromes? Study of 93 Patients with PET/CT from a Single Center [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/classic-and-atypical-polymyalgia-rheumatica-are-different-syndromes-study-of-93-patients-with-pet-ct-from-a-single-center/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/classic-and-atypical-polymyalgia-rheumatica-are-different-syndromes-study-of-93-patients-with-pet-ct-from-a-single-center/