Skip to main content

Advertisement

SpringerLink
Log in

Value of 18F-FDG PET/CT for therapeutic assessment of patients with polymyalgia rheumatica receiving tocilizumab as first-line treatment

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the use of 18F-FDG PET/CT for the assessment of tocilizumab (TCZ) as first-line treatment in patients with polymyalgia rheumatica (PMR).

Methods

Patients with PMR were prospectively enrolled in a multicentre clinical trial assessing TCZ therapy (the TENOR trial). The patients underwent FDG PET/CT at baseline, after the first infusion of TCZ (TCZ 1) and after the last infusion of TCZ (TCZ 3). Responses to treatment were evaluated in terms of the PMR activity score (PMR-AS), and the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) laboratory tests. Maximal standardized uptake value (SUVmax) was used for assessment of FDG uptake in regions usually affected in PMR (spinous processes, hips, shoulders, sternoclavicular region and ischial tuberosities). The Wilcoxon test was applied to evaluate the changes in parameters after the infusions and Spearman’s rank correlation test was applied to assess the correlations between SUVmax and PMR-AS, CRP and ESR.

Results

Of 21 patients included in the trial, 18 were evaluated. The median bioclinical parameter values decreased after TCZ 1 (PMR-AS from 38.2 to 15.7, CRP from 65.2 to 0.4 mg/l and ESR from 49 to 6.5 mm; all p < 0.05) as did the median SUVmax (from 5.8 to 5.2; p < 0.05). All values also decreased after TCZ 3 (PMR-AS from 38.2 to 3.9, CRP from 65.2 to 0.2, ESR from 49 to 2, and SUVmax from 5.8 to 4.7; p < 0.05). In a region-based analysis, all SUVmax were significantly reduced after TCZ 3, except the values for the cervical spinous processes and shoulder regions. With regard to correlations, few significant differences were found between ∆SUVmax and the other parameters including ∆PMR-AS, ∆CRP and ∆ESR in the patient-based and region-based analysis.

Conclusion

FDG uptake decreased significantly but moderately after TCZ therapy in PMR patients, and might reflect disease activity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Mori S, Koga Y. Glucocorticoid-resistant polymyalgia rheumatica: pretreatment characteristics and tocilizumab therapy. Clin Rheumatol. 2014. doi:10.1007/s10067-014-2650-y.

    PubMed  Google Scholar 

  2. Devauchelle V, Saraux A, Youinou P, Le Goff P. Prevalence of synovitis in patients with polymyalgia rheumatica and/or giant cell arteritis. Rev Rhum Engl Ed. 1997;64:594–5.

    CAS  PubMed  Google Scholar 

  3. Chuang TY, Hunder GG, Ilstrup DM, Kurland LT. Polymyalgia rheumatica: a 10 years epidemiologic and clinical study. Ann Intern Med. 1982;97:672–80.

    Article  CAS  PubMed  Google Scholar 

  4. Salvarani C, Macchioni P, Manzini C, Paolazzi G, Trotta A, Manganelli P, et al. Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial. Ann Intern Med. 2007;146:631–9.

    Article  PubMed  Google Scholar 

  5. Hoffman GS, Cid MC, Rendt-Zagar KE, Merkel PA, Weyand CM, Stone JH, et al. Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis: a randomized trial. Ann Intern Med. 2007;146:621–30.

    Article  PubMed  Google Scholar 

  6. Hernandez-Rodriguez J, Cid MC, Lopez-Soto A, Espigol-Frigole G, Bosch X. Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med. 2009;169:1839–50.

    Article  CAS  PubMed  Google Scholar 

  7. Devauchelle-Pensec V, Jousse S, Destombe C, Saraux A. Epidemiology, imaging, and treatment of giant cell arteritis. Joint Bone Spine. 2008;75(3):267–72.

    Article  PubMed  Google Scholar 

  8. Caporali R, Cimmino MA, Ferraccioli G, Gerli R, Klersy C, Salvarani C, et al. Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2004;141:493–500.

    Article  CAS  PubMed  Google Scholar 

  9. Alvarez-Rodriguez L, Lopez-Hoyos M, Mata C, Marin MJ, Calvo-Alen J, Blanco R, et al. Circulating cytokines in active polymyalgia rheumatica. Ann Rheum Dis. 2010;69:263–9.

    Article  CAS  PubMed  Google Scholar 

  10. Hagihara K, Kawase I, Tanaka T, Kishimoto T. Tocilizumab ameliorates clinical symptoms in polymyalgia rheumatica. J Rheumatol. 2010;37:1075–6.

    Article  PubMed  Google Scholar 

  11. Loricera J, Blanco R, Castaneda S, Humbría A, Ortego-Centeno N, Narváez J, et al. Tocilizumab in refractory aortitis: study on 16 patients and literature review. Clin Exp Rheumatol. 2014;32(3 Suppl 82):S79–89.

    PubMed  Google Scholar 

  12. Leeb BF, Bird HA. A disease activity score for polymyalgia rheumatica. Ann Rheum Dis. 2004;63:1279–83.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Cleuziou C, Binard A, De Bandt M, Berthelot JM, Saraux A. Contribution of the polymyalgia rheumatica activity score to glucocorticoid dosage adjustment in everyday practice. J Rheumatol. 2012;39:310–3.

    Article  CAS  PubMed  Google Scholar 

  14. Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Müeller SP, et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol. 2014;32:3048–58.

    Article  PubMed  Google Scholar 

  15. Weber WA, Wieder H. Monitoring chemotherapy and radiotherapy of solid tumors. Eur J Nucl Med Mol Imaging. 2006;33:27–37.

    Article  PubMed  Google Scholar 

  16. Nanni C, Boriani L, Salvadori C, Zamparini E, Rorato G, Ambrosini V, et al. FDG PET/CT is useful for the interim evaluation of response to therapy in patients affected by haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging. 2012;39:1538–44.

    Article  PubMed  Google Scholar 

  17. Guleria R, Jyothidasan A, Madan K, Mohan A, Kumar R, Bhalla AS, et al. Utility of FDG-PET-CT scanning in assessing the extent of disease activity and response to treatment in sarcoidosis. Lung India. 2014;31:323–30.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Yamashita H, Kubota K, Mimori A. Clinical value of whole-body PET/CT in patients with active rheumatic diseases. Arthritis Res Ther. 2014;16:423.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Blockmans D, Stroobants S, Maes A, Mortelmans L. Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med. 2000;108:246–9.

    Article  CAS  PubMed  Google Scholar 

  20. Blockmans D, De Ceuninck L, Vanderschueren S, Knockaert D, Mortelmans L, Bobbaers H. Repetitive 18-fluorodeoxyglucose positron emission tomography in isolated polymyalgia rheumatica: a prospective study in 35 patients. Rheumatology (Oxford). 2007;46:672–7.

    Article  CAS  Google Scholar 

  21. Kotani T, Komori T, Kanzaki Y, Takeuchi T, Wakura D, Iimori A, et al. FDG-PET/CT of polymyalgia rheumatica. Mod Rheumatol. 2011;21:334–6.

    Article  PubMed  Google Scholar 

  22. Yamashita H, Kubota K, Takahashi Y, Minamimoto R, Morooka M, Kaneko H, et al. Similarities and differences in fluorodeoxyglucose positron emission tomography/computed tomography findings in spondyloarthropathy, polymyalgia rheumatica and rheumatoid arthritis. Joint Bone Spine. 2013;80:171–7.

    Article  PubMed  Google Scholar 

  23. Yamashita H, Kubota K, Takahashi Y, Minaminoto R, Morooka M, Ito K, et al. Whole-body fluorodeoxyglucose positron emission tomography/computed tomography in patients with active polymyalgia rheumatica: evidence for distinctive bursitis and large-vessel vasculitis. Mod Rheumatol. 2012;22:705–11.

    Article  PubMed  Google Scholar 

  24. Toriihara A, Seto Y, Yoshida K, Umehara I, Nakagawa T, Liu R, et al. F-18 FDG PET/CT of polymyalgia rheumatica. Clin Nucl Med. 2009;34:305–6.

    Article  PubMed  Google Scholar 

  25. Besson FL, Parienti JJ, Bienvenu B, Prior JO, Costo S, Bouvard G, et al. Diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2011;38:1764–72.

    Article  PubMed  Google Scholar 

  26. Al Rashidi A, Hegazi MO, Mohammad SA, Varghese A. Effective control of polymyalgia rheumatica with tocilizumab. J Clin Rheumatol. 2013;19:400–1.

    Article  PubMed  Google Scholar 

  27. Macchioni P, Boiardi L, Catanoso M, Pulsatelli L, Pipitone N, Meliconi R, et al. Tocilizumab for polymyalgia rheumatica: report of two cases and review of the literature. Semin Arthritis Rheum. 2013;43:113–8.

    Article  CAS  PubMed  Google Scholar 

  28. Okamura K, Yonemoto Y, Arisaka Y, Takeuchi K, Kobayashi T, Oriuchi N, et al. The assessment of biologic treatment in patients with rheumatoid arthritis using FDG-PET/CT. Rheumatology (Oxford). 2012;51:1484–91.

    Article  CAS  Google Scholar 

  29. Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum. 2008;58:2958–67.

    Article  CAS  PubMed  Google Scholar 

  30. Kanstrup IL, Klausen TL, Bojsen-Møller J, Magnusson P, Zerahn B. Variability and reproducibility of hepatic FDG uptake measured as SUV as well as tissue-to-blood background ratio using positron emission tomography in healthy humans. Clin Physiol Funct Imaging. 2009;29(2):108–13.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Brest University Hospital, 2 Avenue FOCH, 26609, Brest Cedex, France

    X. Palard-Novello, S. Querellou, R. Abgral & P. Y. Salaün

  2. Clinical Investigation Centre (CIC) 1412, Institut National de la Santé et de la Recherche Médicale (INSERM), Brest, France

    M. Gouillou

  3. Department of Rheumatology, Brest University Hospital, Brest, France

    A. Saraux, T. Marhadour & V. Devauchelle-Pensec

  4. Department of Radiology, Brest University Hospital, Brest, France

    F. Garrigues

  5. EA3878, GETBO, IFR148, Brest University, Brest, France

    S. Querellou, R. Abgral & P. Y. Salaün

  6. EA 2216, ESPRI 29, Brest University, Brest, France

    A. Saraux & V. Devauchelle-Pensec

Authors
  1. X. Palard-Novello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Querellou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Gouillou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Saraux
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Marhadour
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Garrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Abgral
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Y. Salaün
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. V. Devauchelle-Pensec
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to X. Palard-Novello.

Ethics declarations

Funding

Roche-Chugai provided an unconditional grant for the study. Tocilizumab was donated free of charge by Roche-Chugai. Roche-Chugai had no role in the design or conduct of the study, or the management of the collection, analysis or interpretation of the data, or in the preparation, revision or approval of the manuscript.

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palard-Novello, X., Querellou, S., Gouillou, M. et al. Value of 18F-FDG PET/CT for therapeutic assessment of patients with polymyalgia rheumatica receiving tocilizumab as first-line treatment. Eur J Nucl Med Mol Imaging 43, 773–779 (2016). https://doi.org/10.1007/s00259-015-3287-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-015-3287-z

Keywords

Search

Navigation