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

  • X. Palard-NovelloEmail author
  • S. Querellou
  • M. Gouillou
  • A. Saraux
  • T. Marhadour
  • F. Garrigues
  • R. Abgral
  • P. Y. Salaün
  • V. Devauchelle-Pensec
Original Article



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).


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.


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.


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


18F-FDG PET/CT Polymyalgia rheumatica Cytokines Inflammation Therapeutic assessment 


Compliance with ethical standards


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


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.


  1. 1.
    Mori S, Koga Y. Glucocorticoid-resistant polymyalgia rheumatica: pretreatment characteristics and tocilizumab therapy. Clin Rheumatol. 2014. doi: 10.1007/s10067-014-2650-y.PubMedGoogle Scholar
  2. 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.PubMedGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 10.
    Hagihara K, Kawase I, Tanaka T, Kishimoto T. Tocilizumab ameliorates clinical symptoms in polymyalgia rheumatica. J Rheumatol. 2010;37:1075–6.CrossRefPubMedGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 12.
    Leeb BF, Bird HA. A disease activity score for polymyalgia rheumatica. Ann Rheum Dis. 2004;63:1279–83.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 15.
    Weber WA, Wieder H. Monitoring chemotherapy and radiotherapy of solid tumors. Eur J Nucl Med Mol Imaging. 2006;33:27–37.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 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.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 26.
    Al Rashidi A, Hegazi MO, Mohammad SA, Varghese A. Effective control of polymyalgia rheumatica with tocilizumab. J Clin Rheumatol. 2013;19:400–1.CrossRefPubMedGoogle Scholar
  27. 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.CrossRefPubMedGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • X. Palard-Novello
    • 1
    Email author
  • S. Querellou
    • 1
    • 5
  • M. Gouillou
    • 2
  • A. Saraux
    • 3
    • 6
  • T. Marhadour
    • 3
  • F. Garrigues
    • 4
  • R. Abgral
    • 1
    • 5
  • P. Y. Salaün
    • 1
    • 5
  • V. Devauchelle-Pensec
    • 3
    • 6
  1. 1.Department of Nuclear MedicineBrest University HospitalBrest CedexFrance
  2. 2.Clinical Investigation Centre (CIC) 1412Institut National de la Santé et de la Recherche Médicale (INSERM)BrestFrance
  3. 3.Department of RheumatologyBrest University HospitalBrestFrance
  4. 4.Department of RadiologyBrest University HospitalBrestFrance
  5. 5.EA3878, GETBO, IFR148Brest UniversityBrestFrance
  6. 6.EA 2216, ESPRI 29Brest UniversityBrestFrance

Personalised recommendations