ABSTRACT
Objectives: Excessive bone formation is an important hallmark of AS. Recently it has been demonstrated that axial bony lesions in AS patients can be visualized using 18F-fluoride PET-CT. The aim of this study was to assess whether 18F-fluoride uptake in clinically active AS patients is related to focal bone formation in spine biopsies and is sensitive to change during anti-TNF treatment. Methods: Twelve anti-TNF-naïve AS patients [female 7/12; age 39 years (SD 11); BASDAI 5.5 ± 1.1] were included. 18 F-fluoride PET-CT scans were performed at baseline and in two patients, biopsies were obtained from PET-positive and PET-negative spine lesions. The remaining 10 patients underwent a second 18F-fluoride PET-CT scan after 12 weeks of anti-TNF treatment. PET scans were scored visually by two blinded expert readers. In addition, 18F-fluoride uptake was quantified using the standardized uptake value corrected for individual integrated whole blood activity concentration (SUVAUC). Clinical response to anti-TNF was defined according to a ⩾ 20% improvement in Assessment of SpondyloArthritis international Society criteria at 24 weeks. Results: At baseline, all patients showed at least one axial PET-positive lesion. Histological analysis of PET-positive lesions in the spine confirmed local osteoid formation. PET-positive lesions were found in the costovertebral joints (43%), facet joints (23%), bridging syndesmophytes (20%) and non-bridging vertebral lesions (14%) and in SI joints (75%). After 12 weeks of anti-TNF treatment, 18F-fluoride uptake in clinical responders decreased significantly in the costovertebral (mean SUVAUC -1.0; P < 0.001) and SI joints (mean SUVAUC -1.2; P = 0.03) in contrast to non-responders. Conclusions: 18F-fluoride PET-CT identified bone formation, confirmed by histology, in the spine and SI joints of AS patients and demonstrated alterations in bone formation during anti-TNF treatment.
Subject(s)
Antirheumatic Agents/therapeutic use , Fluorodeoxyglucose F18/pharmacology , Osteogenesis/physiology , Spine/diagnostic imaging , Spondylitis, Ankylosing/diagnostic imaging , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adolescent , Adult , Aged , Biopsy , Female , Follow-Up Studies , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals/pharmacology , Spondylitis, Ankylosing/drug therapy , Young AdultABSTRACT
INTRODUCTION: The aim of this study was to determine the prevalence of gastrointestinal and behavioural symptoms occurring before (anticipatory/associative) and after methotrexate (MTX) administration, termed MTX intolerance, in rheumatoid (RA) and psoriatic arthritis (PsA). METHODS: Methotrexate Intolerance Severity Score (MISS), previously validated in juvenile idiopathic arthritis patients, was used to determine MTX intolerance prevalence in 291 RA/PsA patients. The MISS consisted of four domains: abdominal pain, nausea, vomiting and behavioural symptoms, occurring upon, prior to (anticipatory) and when thinking of MTX (associative). MTX intolerance was defined as ≥6 on the MISS with ≥1 point on anticipatory and/or associative and/or behavioural items. RESULTS: A total of 123 patients (42.3%) experienced at least one gastrointestinal adverse effect. The prevalence of MTX intolerance was 11%. MTX intolerance prevalence was higher in patients on parenteral (20.6%) than on oral MTX (6.2%) (p < 0.001). CONCLUSION: Besides well-known gastrointestinal symptoms after MTX, RA and PsA patients experienced these symptoms also before MTX intake. RA and PsA patients on MTX should be closely monitored with the MISS for early detection of MTX intolerance, in order to intervene timely and avoid discontinuation of an effective treatment.
Subject(s)
Anti-Inflammatory Agents/adverse effects , Arthritis, Psoriatic/drug therapy , Arthritis, Rheumatoid/drug therapy , Gastrointestinal Diseases/chemically induced , Methotrexate/adverse effects , Cross-Sectional Studies , Female , Gastrointestinal Diseases/epidemiology , Humans , Male , Middle Aged , PrevalenceABSTRACT
A 57-year-old woman presented with malaise and heaviness in her extremities. At first there were no clues of an inflammatory disease, but the patient developed slowly progressive oedema of her arms and legs with induration of the skin. Blood tests showed eosinophilia. Additional analysis revealed generalised lymphadenopathy. After excluding an infectious or malignant cause, the clinical diagnosis of eosinophilic fasciitis was made, this was confirmed by the results of a full thickness skin biopsy.
Subject(s)
Eosinophilia/diagnosis , Fasciitis/diagnosis , Anti-Inflammatory Agents/therapeutic use , Eosinophilia/drug therapy , Eosinophilia/pathology , Fasciitis/drug therapy , Fasciitis/pathology , Female , Forearm , Humans , Middle Aged , Prednisone/therapeutic use , Skin/pathologyABSTRACT
A 19-year-old female patient presented with headache, nausea, hypertension, visual impairment of the left eye and exertion-related complaints of palpitations since 1 year. Fundoscopy showed severe hypertensive retinopathy grade IV. A paraganglioma in the left para-aortic region was diagnosed by urinary screening and magnetic resonance imaging scanning. The tumor was resected by a robot-assisted laparoscopic procedure. The surgical operating time was 250 minutes and the blood loss was 150 mL. After surgery the blood pressure normalized and antihypertensive drugs were no longer required. Oral intake was resumed on the first postoperative day and the hospital stay was 3 days. Final pathology examination revealed a paraganglioma with pheochromocytomal features of 7x5.1x3.5 cm. Reports on laparoscopic resection of large paragangliomas are scarce. This case has demonstrated that the procedure is feasible and associated with rapid recovery from surgery. The surgical team experienced explicit support by the robot in the dissection of this highly vascularized tumor.
