Journal Article The natural history of asymptomatic positron emission tomography: positive giant cell arteritis after a case of self-limiting polymyalgia rheumatica Get access Hiroyuki Yamashita, Hiroyuki Yamashita Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan Correspondence to: Hiroyuki Yamashita, Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan e-mail: hiroyuki_yjp2005@yahoo.co.jp Search for other works by this author on: Oxford Academic Google Scholar Mariko Inoue, Mariko Inoue Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan Search for other works by this author on: Oxford Academic Google Scholar Yuko Takahashi, Yuko Takahashi Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan Search for other works by this author on: Oxford Academic Google Scholar Toshikazu Kano, Toshikazu Kano Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan Search for other works by this author on: Oxford Academic Google Scholar Akio Mimori Akio Mimori Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan Search for other works by this author on: Oxford Academic Google Scholar Modern Rheumatology, Volume 22, Issue 6, 1 November 2012, Pages 942–946, https://doi.org/10.3109/s10165-012-0689-7 Published: 01 November 2012 Article history Received: 29 February 2012 Accepted: 28 May 2012 Published: 01 November 2012
To compare the fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) findings in patients with elderly-onset rheumatoid arthritis (EORA) with those in patients with polymyalgia rheumatica (PMR), two conditions with similar clinical presentations.We retrospectively analyzed the FDG-PET/CT findings in 10 patients with EORA and 27 patients with PMR admitted to our department between 2006 and 2012.No significant difference was observed in the median patient ages at the time of FDG-PET/CT scans in the EORA and PMR groups (73.5 vs. 78.0 years, respectively). Significant differences in both FDG uptake scores and standardized uptake values were observed between the two groups in the ischial tuberosities, spinous processes, and wrists. No significant differences were detected in the shoulders and hips. However, specific uptake patterns were observed in each group: circular and linear uptake patterns were observed around the humeral head in the EORA group, whereas focal and non-linear uptake patterns were observed in the PMR group. Moreover, focal uptake in front of the hip joint, indicating iliopectineal bursitis, tended to be limited to the PMR group. High sensitivity (92.6%) and specificity (90%) were observed for PMR diagnoses when at least three of the following five items were satisfied: characteristic findings of shoulder and iliopectineal bursitis, FDG uptake in ischial tuberosities and spinal spinous processes, and lack of FDG uptake in the wrists.The differences in the degree of uptake at each lesion and in uptake patterns at the shoulders and hips are potentially useful for obtaining a definitive diagnosis.
Journal Article Lifestyle and other related factors for the development of mixed connective tissue disease among Japanese females in comparison with systemic lupus erythematosus Get access Masakazu Washio, Masakazu Washio Department of Community Health and Clinical Epidemiology, St. Mary's College, Kurume, Japan Correspondence to: Masakazu Washio, MD, Department of Community Health and Clinical Epidemiology, St. Mary's College, 422 Tsubuku-hon-machi, Kurume 930-8558, Japan. Tel: +81-942-35-7271. Fax: +81-942-34-9125. E-mail: washio@st-mary.ac.jp Search for other works by this author on: Oxford Academic Google Scholar Takao Fujii, Takao Fujii Graduate School of Medicine, Kyoto University, Kyoto, Japan Search for other works by this author on: Oxford Academic Google Scholar Masataka Kuwana, Masataka Kuwana Keio University School of Medicine, Tokyo, Japan Search for other works by this author on: Oxford Academic Google Scholar Yasushi Kawaguchi, Yasushi Kawaguchi Tokyo Women's Medical University, Tokyo, Japan Search for other works by this author on: Oxford Academic Google Scholar Akio Mimori, Akio Mimori Division of Rheumatic Disease, National Center for Global Health and Medicine, Tokyo, Japan Search for other works by this author on: Oxford Academic Google Scholar Takahiko Horiuchi, Takahiko Horiuchi Kyushu University Beppu Hospital, Beppu, Japan Search for other works by this author on: Oxford Academic Google Scholar Yoshifumi Tada, Yoshifumi Tada Faculty of Medicine Saga University, Saga, Japan Search for other works by this author on: Oxford Academic Google Scholar Hiroki Takahashi, Hiroki Takahashi Sapporo Medical University, Sapporo, Japan Search for other works by this author on: Oxford Academic Google Scholar Tsuneyo Mimori, Tsuneyo Mimori Graduate School of Medicine, Kyoto University, Kyoto, Japan Search for other works by this author on: Oxford Academic Google Scholar Japan MCTD study group Japan MCTD study group Search for other works by this author on: Oxford Academic Google Scholar Modern Rheumatology, Volume 24, Issue 5, 1 September 2014, Pages 788–792, https://doi.org/10.3109/14397595.2013.863442 Published: 01 September 2014 Article history Received: 27 August 2013 Accepted: 03 November 2013 Published: 01 September 2014
Objectives. While there are a few reports describing 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) findings in patients with adult-onset Still's disease (AOSD), no summary report has yet been published. In this study, we evaluated the usefulness of FDG-PET/CT for diagnosis and activity evaluation in patients with AOSD by summarizing the findings of our patients and those reported in the literature. Methods. Seven consecutive AOSD patients who had undergone PET/CT at our department between 2007 and 2012 were included. We evaluated FDG uptake for characteristic findings in patients with AOSD. In addition, we reviewed the literature on seven previously reported AOSD patients who had undergone PET/CT. Results. FDG accumulation was positive mainly in the bone marrow (100%), spleen (90.9%), lymph nodes (80.0%) and joints (75.0%). In addition, FDG uptake was positive in the pericardium, pleura, salivary glands, eyelids, muscle and major blood vessels. Six patients underwent follow-up FDG PET/CT for evaluation of treatment efficacy. Follow-up PET/CT showed diminished FDG accumulation in the bone marrow, spleen and lymph nodes, with maximum standardized uptake value (SUVmax) being substantially reduced from 4.03 ± 0.95 to 2.20 ± 0.75 (p = 0.04), 4.04 ± 1.10 to 2.55 ± 1.13 (p = 0.04) and 5.63 ± 4.99 to 2.10 ± 1.91 (p = 0.11), respectively. No significant correlation was found between SUVmax in each lesion and the laboratory data, except for a significant correlation between lactate dehydrogenase (LDH) and spleen SUV. Conclusions. FDG-PET/CT is useful for long-term assessments of AOSD activity in individual patients. However, PET/CT findings alone are not sufficient to make a differential diagnosis of AOSD versus malignant lymphoma.
The prognosis of lupus nephritis (LN) was studied retrospectively in two LN categories, LN manifested initially at systemic lupus erythematosus (SLE) onset (I-LN) and LN of delayed manifestation after SLE onset (D-LN), based on a chart review (C) of 154 SLE (85 LN) patients with a mean observation of 20.8 ± 9.3 years and a questionnaire study (Q) of 125 LN patients outside our hospital with mean observation of 17.6 ± 9.2 years. In both study groups, half of I-LN patients were relapse-free by Kaplan–Meier analysis after initial therapy, and the relapsed I-LN patients responded to retherapy at higher 5-year relapse-free rates than those of patients receiving initial therapies for D-LN. At last observation, a higher frequency of prolonged remission was shown in I-LN compared with D-LN patients (C: 22/31, 71% versus 14/49, 29%, P < 0.01; Q: 65/89, 73% versus 11/33, 33% P < 0.01) and also a higher frequency of irreversible renal damage in D-LN compared with I-LN patients (C: 25/49, 51% versus 2/31, 6%, P < 0.001; Q: 14/33, 42% versus 6/89, 7%, P < 0.001), although class IV pathology was common in patients (C) in both LN categories. Onset time of lupus nephritis in the course of SLE may affect renal prognosis.
[ 18 F]Fluorodeoxyglucose (FDG) is a tracer for glucose metabolism. Its distribution is not specific to cancer cells but is also observed in inflammatory tissue, including macrophages, capillaries, and fibroblasts. Rheumatoid arthritis (RA) is a systemic, chronic inflammation of the joints resulting in synovitis. The disease is characterized by fibrovascular proliferation leading to the formation of a pannus and causing high FDG uptake. Several clinical studies of RA have demonstrated that FDG uptake in affected joints reflects the disease activity of RA, with strong correlations between uptake and various clinical parameters having been noted. Furthermore, the use of FDG PET for the sensitive detection and monitoring of the response to RA therapy has been reported. FDG PET/computed tomography (CT) enables the detailed evaluation of disease in large joints throughout the whole body, which is a unique advantage of PET/CT. FDG PET/CT can also be used to detect high‐risk disease complications, such as atlanto‐axial joint involvement, at an early stage. The possible contribution of FDG PET to the management of patients with RA remains to be studied in detail.
