Prognostic impacts of glucocorticoid treatment in patients with polymyalgia rheumatica and giant cell arteritis

AbstractIdentifying comorbidities in polymyalgia rheumatica/giant cell arteritis (PMR/GCA) is crucial for patients’ outcomes. The present study aimed to evaluate the impact of the inflammatory process and glucocorticoid treatment on aortic arterial stiffness and body composition in PMR/GCA. 77 patients with newly diagnosed PMR/GCA were treated with oral glucocorticoids and followed for 40 weeks. Aortic pulse wave velocity (PWV) was measured at baseline and during the follow-up period and compared to the results of temporal artery biopsy (TAB) and 18F-FDG PET/CT. Body composition was assessed by total body DXA at baseline and the end of the study. Of 77 patients (49 (63.6%) female, mean of age: (71.8 ± 8.0)), 64 (83.1%) had pure PMR, 10 (13.0%) concomitant PMR and GCA, and 3 (3.9%) pure GCA. Compared to baseline values, aortic PWV was initially decreased at week 16 (p = 0.010) and remained lower than baseline at week 28 (p = 0.002) and week 40 (p < 0.001), with no association with results of TAB and 18F-FDG PET/CT. Aortic PWV was significantly associated with age, male gender, left systolic and diastolic blood pressure, right diastolic blood pressure, and CRP. Total bone mineral content (BMC) was decreased in both genders (p < 0.001), while fat mass (FM) was significantly increased (p < 0.001). However, lean body mass did not significantly change during the study. Changes in FM were correlated with cumulative prednisolone dose (rho: 0.26, p = 0.031). Glucocorticoid treatment of patients with PMR/GCA had several prognostic impacts. Arterial stiffness was decreased due either to the treatment or a reduction in the inflammatory load. Additionally, treatment led to changes in body composition, including a decrease in BMC and FM excess.

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Bilateral Vertebral Artery Vasculitis—A Rare Manifestation of Giant Cell Arteritis and a Difficult Diagnosis Made Possible by 2-[18F]FDG PET/CT

Diagnostics ◽

10.3390/diagnostics11050879 ◽

2021 ◽

Vol 11 (5) ◽

pp. 879

Author(s):

Natasja Justesen ◽

Michael Hansen ◽

Mads Jensen ◽

Oliver Klefter ◽

Jane Brittain ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Fdg Pet ◽

Temporal Artery ◽

High Dose ◽

Temporal Artery Biopsy ◽

Glucocorticoid Treatment ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

: Giant cell arteritis (GCA) is the most common form of large vessel vasculitis. GCA is a medical and ophthalmological emergency, and rapid diagnosis and treatment with high-dose corticosteroids is critical in order to reduce the risk of stroke and sudden irreversible loss of vision. GCA can be difficult to diagnose due to insidious and unspecific symptoms—especially if typical superficial extracranial arteries are not affected. In these cases, verification of clinical diagnosis using temporal artery biopsy is not possible. This example illustrates the diagnostic value of hybrid imaging with 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT), and the limitations of the temporal artery biopsy in bilateral vertebral GCA, causing transient ischemic attack in the visual cortex. In addition it indicates that inflammation in the artery wall can be visualized on 2-[18F]FDG PET/CT despite long term and ongoing high dose glucocorticoid treatment.

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The Utility of 18F‐FDG PET/CT in Patients With Clinical Suspicion of Polymyalgia Rheumatica and Giant Cell Arteritis: A Prospective, Observational, and Cross‐sectional Study

ACR Open Rheumatology ◽

10.1002/acr2.11163 ◽

2020 ◽

Author(s):

Amir Emamifar ◽

Torkell Ellingsen ◽

Søren Hess ◽

Oke Gerke ◽

Rasmus Hviid Larsen ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Cross Sectional Study ◽

Clinical Suspicion ◽

Sectional Study ◽

Cross Sectional ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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JAK Inhibitor Effectiveness in Giant-Cell Arteritis With Large-Vessel Involvement Assessed by 18F-FDG PET-CT

Clinical Nuclear Medicine ◽

10.1097/rlu.0000000000003913 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Kevin Prigent ◽

Achille Aouba ◽

Nicolas Aide ◽

Hubert de Boysson

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Fdg Pet ◽

Large Vessel ◽

Jak Inhibitor ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Vessel Involvement

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Diagnosis and assessment of the treatment response in a case of giant cell arteritis using 18F-FDG PET/CT

Revista Española de Medicina Nuclear e Imagen Molecular ◽

10.1016/j.remn.2012.01.007 ◽

2012 ◽

Vol 31 (4) ◽

pp. 233-235

Author(s):

I. Martínez-Rodríguez ◽

R. Del Castillo-Matos ◽

A. Rubio-Vassallo ◽

F. Ortega-Nava ◽

N.A. Martínez-Amador ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Treatment Response ◽

Giant Cell ◽

Fdg Pet ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Opportunistic body composition evaluation in patients with esophageal adenocarcinoma: association of survival with 18F-FDG PET/CT muscle metrics

Annals of Nuclear Medicine ◽

10.1007/s12149-019-01429-7 ◽

2019 ◽

Vol 34 (3) ◽

pp. 174-181 ◽

Cited By ~ 3

Author(s):

Cathy Zhou ◽

Brent Foster ◽

Rosalie Hagge ◽

Cameron Foster ◽

Leon Lenchik ◽

...

Keyword(s):

Body Composition ◽

Esophageal Adenocarcinoma ◽

Fdg Pet ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Giant cell arteritis on 18F-FDG PET/CT

Clinical Physiology and Functional Imaging ◽

10.1111/j.1475-097x.2009.00881.x ◽

2009 ◽

Vol 29 (5) ◽

pp. 382-384 ◽

Cited By ~ 3

Author(s):

Thomas F. Heston ◽

Zsolt Szabo

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Fdg Pet ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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[18F]-FDG PET/CT Scan Detected Giant Cell Arteritis After Negative Temporal Artery Biopsy

The Open Nuclear Medicine Journal ◽

10.2174/1876388x01103010007 ◽

2011 ◽

Vol 3 (1) ◽

pp. 7-9 ◽

Cited By ~ 2

Author(s):

Pamela Medina-Quiroz

Keyword(s):

Ct Scan ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Fdg Pet ◽

Temporal Artery ◽

Temporal Artery Biopsy ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

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Clinical presentation and treatment response in patients with polymyalgia rheumatica and giant cell arteritis during a 40-week follow-up

Rheumatology Advances in Practice ◽

10.1093/rap/rkab091 ◽

2021 ◽

Author(s):

Amir Emamifar ◽

Søren Hess ◽

Torkell Ellingsen ◽

Oke Gerke ◽

Ziba Ahangarani Farahani ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Treatment Response ◽

Giant Cell ◽

Clinical Features ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Temporal Artery Biopsy ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Objectives To study the clinical features of polymyalgia rheumatica and/or giant cell arteritis (PMR/GCA) and clinical predictors of treatment response during a 40-week follow-up period. Method Clinical data on 77 patients with newly diagnosed PMR/GCA who were treated by oral glucocorticoids were gathered at baseline and during 40-week follow-up period. A unilateral temporal artery biopsy (TAB) and 18 F-FDG PET/CT were undertaken at diagnosis. In total, each patient was seen at 5 occasions i.e. baseline, weeks 4, 16, 28, and 40. Treatment response was assessed considering clinical evaluations and results of inflammatory markers. Results Of 77 patients (49(63.6%) female, mean age : 71.8 ± 8.0), 64(83.1%) patients had pure PMR, 10(13.0%) concomitant PMR and GCA, and 3(3.9%) pure GCA. The patients reported clinical symptoms except scalp pain and duration of morning stiffness improved significantly at week 4 and remained lower at week 40 compared with the relative frequencies at baseline. Besides, all components of physical examination showed significant improvement and remained lower at week 40 compared with the baseline. 68.7%, 62.9%, 44.1% and 33.3% of the patients had a complete response at weeks 4, 16, 28, and 40, respectively. Several clinical features including female gender, younger age, fewer relapse, and lower level of baseline ESR were significantly associated with a better treatment response. Treatment response during follow-up period was independent of TAB results and FDG uptakes on 18 F-FDG PET/CT at diagnosis. Conclusion Obtaining valid disease specific outcome measures for evaluating treatment efficacy in PMR and GCA, that can be applied universally is clearly an unmet clinical need. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT02985424

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Clinical implication of FDG-PET/CT in monitoring disease activity in large-vessel giant cell arteritis linked with secondary polymyalgia rheumatica

Case Reports in Internal Medicine ◽

10.5430/crim.v1n1p6 ◽

2014 ◽

Vol 1 (1) ◽

pp. 6 ◽

Cited By ~ 2

Author(s):

Yoshinori Taniguchi ◽

Shuichi Nakayama ◽

Yoshio Terada

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Pelvic Girdle ◽

Large Vessel ◽

Pelvic Girdle Pain ◽

Low Grade ◽

Pet Ct ◽

Fdg Pet Ct

Seventy year-old female presented low-grade fever, neck and pelvic girdle pain, jaw claudication and pulseless without visual disturbance. Laboratory examinations showed that C-reactive protein and erythrocyte sedimentation rate (ESR) were 11 mg/dl and 123 mm/1hr, respectively. FDG-PET/CT findings demonstrated bilateral subclavian, carotid and femoral arteritis and aortitis in addition to bursitis and enthesitis of spinous process and pelvic girdle. We diagnosed as large-vessel giant cell arteritis (GCA) linked with secondary polymyalgia rheumatica (PMR). Glucocorticoid therapy was started, and not only these symptoms and but also abnormal findings of FDG-PET/CT were improved.

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