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McMaster Textbook of Internal Medicine

Imaging studies in patients with PMR

2018-02-28
Bhaskar Dasgupta

Is it necessary to perform imaging studies looking for vasculitides, such as aortitis, in all patients with polymyalgia rheumatica (PMR)? What imaging studies are recommended?

Bhaskar Dasgupta: We do ultrasound and we look at the intimal-medial thickness in the axillary arteries. We do a positron emission tomography (PET) scan, 18F-fluorodeoxyglucose PET computed tomography (18FDG-PET/CT), which will show the inflammation in the aorta, also mainly in the axillary arteries. Upper limb arteries are involved in large-vessel giant cell arteritis (GCA). [These patients] can also have involvement of the carotids, and the vertebral arteries can be involved. So yes, these are the patients we definitely should be imaging with ultrasound and with 18FDG-PET/CT.

See also
  • Febuxostat in the treatment of chronic gout What is the current role of febuxostat in the treatment of chronic gout?
  • Tests in patients with suspected GCA What tests should be performed in the case of suspected giant cell arteritis (GCA)? What should we look for in the physical examination, laboratory tests, and imaging studies?
  • Axial SpA: diagnostics, treatment, disease activity Dr Filip Van den Bosch, associate professor of rheumatology at Ghent University, Belgium, reviews the current diagnostic methods, treatment, and activity measurement used in patients with nonradiographic axial spondyloarthritis in a conversation with Dr Mariusz Korkosz.
  • Polymyalgia rheumatica: current management A lecture by Prof. Bhaskar Dasgupta, from Southend University Hospital, UK, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2016.
  • Current management of gout A lecture by Dr George Nuki, from University of Edinburgh, UK, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
  • Monitoring disease activity in GCA How to monitor disease activity in patients with giant cell arteritis (GCA)? Is it useful to measure interleukin 6 levels, or are inflammatory markers (ESR, CRP) sufficient?
  • 2016 EULAR guidelines: The most important change in gout management What are the new implications for clinical practice of the new 2016 European League Against Rheumatism (EULAR) recommendations for the management of gout?
  • Periarticular injections in the treatment of acute gout flares Are periarticular injections used in the treatment of acute gout flares?
  • Low-dose colchicine after 12 hours from the onset of gout flare According to the EULAR guidelines, in gout flares colchicine is recommended within 12 hours of the onset of symptoms. Because most patients frequently present after this time, the recommendation concerns self-administration of colchicine and treatment of subsequent flares. Can we use low-dose colchicine if the patient presents after 12 hours from the onset of symptoms? Or should we prefer nonsteroidal anti-inflammatory drugs or steroids?
  • Knee osteoarthritis: When arthroscopy can help In the light of recent studies suggesting limited benefit for arthroscopic surgery in the setting of osteoarthritis, the authors of the review highlight the importance of this intervention in the management of patients with other pathologies involving the knee who may have a concomitant diagnosis of osteoarthritis.

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