Background Polymyalgia rheumatica (PMR) may be associated with arteritis of the aorta and its major branches including temporal artery. The delay in the diagnosis of GCA and therefore, in its treatment can have serious consequences.
Objectives The primary objective of this study is to evaluate by PET / CT scan the incidence of GCA in patients with PMR and the existence of underlying malignancies since, so far, no clear association has been established between them, which is a common clinical concern. The secondary objective is to study the joint involvement in PMR.
Methods We studied prospectively all patients with clinical suspicion of PMR referred to the Rheumatology Unit, the Emergency Department and the Internal Medicine and Rheumatology day hospitals from January 2010 to November 2012. All patients who met the PMR EULAR / ACR 2012 classification criteria1 underwent medical history and physical examination, complete blood tests (including TSH, tumor markers and blood and urine cultures), and chest x-rays. We completed the diagnosis of the remaining patients after other pathologies were excluded, with a PET/CT scan.
Results We studied a total of 26 patients, 15 women and 11 men, with a mean age of 75.9 years. Of these patients, 2 had aortic uptake confirming the diagnosis of GCA. Asthenia was observed in 79% of the patients with PMR and in all patients with GCA. 41% of the PMR patients and 50% of the ACG patients suffered weight loss. All patients had shoulder and/or hip pain. Peripheral arthritis was observed only in the PMR group (15.34%).
As for the specific symptoms of GCA, 3 PMR patients and 1 with GCA patient had headaches. Only 1 patient with a final diagnosis of GCA referred amaurosis fugax and none had jaw claudication.
We observed similar values of mean ESR (71.8 mm / hour in PMR and 62.5mm/hour in GCA) and mean CRP (55.4 mg/l in PMR and 43.9 mg / l in ACG). Rheumatoid factor and anti-CCP antibodies were negative in all cases.
Regarding the results of the PET, besides the two vasculitis, we also diagnosed 1 patient with lymphoma and 1 with colon adenoma with high grade dysplasia (both later confirmed by biopsy). Girdles uptake was observed in 84.6% (n = 22)of the patients, 76.9% (n = 20) in the scapular and 61.5% (n = 16)in the pelvic girdle. There was uptake in the spinal column in 31.6% (n = 9) of the patients and 11% (n = 4) of the patients had uptake in peripheral joints. All patients diagnosed from neoplasia or vasculitis presented uptake in at list one girdle.
Conclusions The PET modified the diagnosis in 4 patients (15.38%), confirming the presence of a disease significant enough to suggest the performance of this study in the diagnostic algorithm of the disease. A larger sample is needed to confirm our initial results.
The PET helped diagnose joint involvement in over 80% of the cases. We observed no clinical or laboratory features that may help in the differential diagnosis of patients.
Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum 2012;64:943-54.
Disclosure of Interest None Declared