RESUMO
PURPOSE: We aimed to assess the impact of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the management of patients with suspected large vessel vasculitis. METHODS: An international expert panel determined diagnoses and clinical management in patients with suspected large vessel vasculitis, with and without the results of (18)F-FDG PET, respectively. The accuracy of the clinical diagnosis and the resulting clinical management with and without the (18)F-FDG PET results were compared using logistic regression models. RESULTS: The analysis included 30 patients referred to a tertiary care centre with large vessel vasculitis and 31 controls. (18)F-FDG PET had an overall sensitivity of 73.3% [95% confidence interval (CI) 54.1-87.7%], a specificity of 83.9% (95% CI 66.3-94.5%), a positive predictive value of 81.5% (95% CI 61.9-93.7%) and a negative predictive value of 76.5% (95% CI 58.8-89.3%). The diagnostic accuracy of (18)F-FDG PET was higher in patients not receiving immunosuppressive drugs (93.3 vs 64.5%, p = 0.006). Taken in context with other available diagnostic modalities, the addition of (18)F-FDG PET increased the clinical diagnostic accuracy from 54.1 to 70.5% (p = 0.04). The addition of (18)F-FDG PET increased the number of indicated biopsies from 22 of 61 patients (36.1%) to 25 of 61 patients (41.0%) and changed the treatment recommendation in 8 of 30 patients (26.7%) not receiving immunosuppressive medication and in 7 of 31 patients (22.6%) receiving immunosuppressive medication. CONCLUSION: (18)F-FDG PET is a sensitive and specific imaging tool for large vessel vasculitis, especially when performed in patients not receiving immunosuppressive drugs. It increases the overall diagnostic accuracy and has an impact on the clinical management in a significant proportion of patients.
Assuntos
Fluordesoxiglucose F18/farmacologia , Compostos Radiofarmacêuticos/farmacologia , Vasculite/diagnóstico por imagem , Vasculite/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arterite/patologia , Estudos de Casos e Controles , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Valor Preditivo dos Testes , Análise de Regressão , Reprodutibilidade dos Testes , Reumatologia/métodos , Sensibilidade e Especificidade , Arterite de Takayasu/patologiaRESUMO
OBJECTIVE: To test the efficacy of Infliximab, a chimeric monoclonal antibody against TNF-alpha, in the treatment of Takayasu arteritis. MATERIALS AND METHODS: We used infliximab at an initial dose of 3 mg/kg i.v. at weeks 0, 2, 6, and 8 thereafter in combination with methotrexate or azathioprine, to treat four patients with Takayasu arteritis. RESULTS: Three out of four patients responded to infliximab treatment, while two of them retained the response during a two-year follow up. A higher dose regimen (5 mg/kg), however, was eventually warranted for two of the responders. No major side effects were noted. CONCLUSIONS: Infliximab might be an effective and safe alternative for patients with Takayasu arteritis.
