Skip to main content

Advertisement

SpringerLink
Log in

Elevated spleen FDG uptake predicts unfavorable outcome in adult idiopathic-inflammatory-myopathy patients: a crisis beyond muscles

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Background

Idiopathic inflammatory myopathy (IIM) is a group of autoimmune diseases that frequently leads to unfavorable outcome. This study aimed at identifying the clinical value of PET/CT scan in predicting the outcome of adult IIM patients.

Methods

Adult IIM patients who were admitted to the four divisions of the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZJU), from January 1, 2017, to December 31, 2020, were retrospectively reviewed. PET/CT scan and other factors of IIM patients who met the inclusion and exclusion criteria were collected and analyzed.

Results

A total of 69 adult IIM patients were finally enrolled into this study. Thirty cases (43.5%) of all the patients enrolled died in follow-up, and the medium follow-up time was 11.90 (4.00, 23.80) months. In particular, 14 patients died within 3 months. The univariate Cox proportional hazards regression analyses revealed pulmonary bacterial infection (P < 0.001), rapidly progressive interstitial lung disease (RP-ILD, P = 0.018), maximum standard uptake value of spleen (spleen SUVmax, P = 0.002), and positivity of anti-MDA5 antibody (P = 0.041) were significantly related to survival in follow-up. The following multivariate Cox proportional hazards regression analysis identified pulmonary bacterial infection (P = 0.003) and spleen SUVmax (P = 0.032) as factors significantly associated with survival of IIM-ILD patients. The subsequent receiver operating characteristic curve analysis showed SUVmax was comparably effective in predicting death within 3 months.

Conclusion

Spleen SUVmax and complication of pulmonary bacterial infection were significantly associated with survival of IIM patients. In addition, elevated spleen SUVmax was efficient in predicting unfavorable outcome of adult IIM patients.

Key Points

• IIM is a group of autoimmune diseases that frequently leads to unfavorable outcome

• Complications of splenic SUVmax and pulmonary bacterial infection were significantly associated with survival in IIM patients

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
Fig. 3

Similar content being viewed by others

References

  1. Saygin D, Oddis CV, Dzanko S, Koontz D, Moghadam-Kia S, Ardalan K et al (2021) Utility of patient-reported outcomes measurement information system (PROMIS) physical function form in inflammatory myopathy. Semin Arthritis Rheum 51(3):539–546

    Article  CAS  Google Scholar 

  2. Hanna B, Sakiniene E, Gjertsson I, Pullerits R, Jin T (2021) Osteopenia/osteoporosis develops in the early phase of disease in patients with idiopathic inflammatory myopathies. Scand J Rheumatol 1–4. Advance online publication

  3. Findlay AR, Goyal NA, Mozaffar T (2015) An overview of polymyositis and dermatomyositis. Muscle Nerve 51(5):638–656

    Article  CAS  Google Scholar 

  4. Barsotti S, Dastmalchi M, Notarnicola A, Leclaire V, Dani L, Gheorghe K et al (2020) Performance of the new EULAR/ACR classification criteria for idiopathic inflammatory myopathies (IIM) in a large monocentric IIM cohort. Semin Arthritis Rheum 50(3):492–497

    Article  CAS  Google Scholar 

  5. Liang J, Xu D, Sun C, Chen W, Cao H, Lin J (2020) Hemophagocytic Lymphohistiocytosis: Prevalence, Risk Factors, Outcome, and Outcome-related Factors in Adult Idiopathic Inflammatory Myopathies. J Rheumatol 47(10):1532–1540

    Article  CAS  Google Scholar 

  6. Mehta P, Agarwal V, Gupta L (2021) High Early Mortality in Idiopathic Inflammatory Myopathies: Results from the Inception Cohort at a Tertiary Care Center in Northern India. Rheumatology (Oxford, England) keab001. Advance online publication

  7. Yamasaki Y, Yamada H, Ohkubo M, Yamasaki M, Azuma K, Ogawa H et al (2011) Longterm survival and associated risk factors in patients with adult-onset idiopathic inflammatory myopathies and amyopathic dermatomyositis: experience in a single institute in Japan. J Rheumatol 38(8):1636–1643

    Article  CAS  Google Scholar 

  8. Nuño-Nuño L, Joven BE, Carreira PE, Maldonado-Romero V, Larena-Grijalba C, Cubas IL et al (2017) Mortality and prognostic factors in idiopathic inflammatory myositis: a retrospective analysis of a large multicenter cohort of Spain. Rheumatol Int 37(11):1853–1861

    Article  Google Scholar 

  9. Tanaka S, Ikeda K, Uchiyama K, Iwamoto T, Sanayama Y, Okubo A et al (2013) [18F]FDG uptake in proximal muscles assessed by PET/CT reflects both global and local muscular inflammation and provides useful information in the management of patients with polymyositis/dermatomyositis. Rheumatology (Oxford) 52(7):1271–1278

    Article  CAS  Google Scholar 

  10. Matuszak J, Blondet C, Geny B, Namer IJ, Meyer A (2019) Comment on: Muscle fluorodeoxyglucose uptake assessed by positron emission tomography-computed tomography as a biomarker of inflammatory myopathies disease activity: reply. Rheumatology (Oxford) 58(12):2345–2346

    Google Scholar 

  11. Motegi SI, Fujiwara C, Sekiguchi A, Hara K, Yamaguchi K, Maeno T et al (2019) Clinical value of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography for interstitial lung disease and myositis in patients with dermatomyositis. J Dermatol 46(3):213–218

    Article  CAS  Google Scholar 

  12. Li Y, Zhou Y, Wang Q (2017) Multiple values of (18)F-FDG PET/CT in idiopathic inflammatory myopathy. Clin Rheumatol 36(10):2297–2305

    Article  Google Scholar 

  13. Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, de Visser M, et al. International Myositis Classification Criteria Project Consortium, the Euromyositis Register, and the Juvenile Dermatomyositis Cohort Biomarker Study and Repository (UK and Ireland) (2017) 2017 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Adult and Juvenile Idiopathic Inflammatory Myopathies and Their Major Subgroups. Arthritis Rheumatol (Hoboken, NJ) 69(12):2271–2282

  14. Sato S, Masui K, Nishina N, Kawaguchi Y, Kawakami A, Tamura M et al (2018) Initial predictors of poor survival in myositis-associated interstitial lung disease: a multicentre cohort of 497 patients. Rheumatology (Oxford) 57(7):1212–1221

    Article  CAS  Google Scholar 

  15. Lilleker JB, Vencovsky J, Wang G, Wedderburn LR, Diederichsen LP, Schmidt J et al (2018) The EuroMyositis registry: an international collaborative tool to facilitate myositis research. Ann Rheum Dis 77(1):30–39

    Article  Google Scholar 

  16. Horiike Y, Suzuki Y, Fujisawa T, Yasui H, Karayama M, Hozumi H et al (2019) Successful classification of macrophage-mannose receptor CD206 in severity of anti-MDA5 antibody positive dermatomyositis associated ILD. Rheumatology (Oxford) 58(12):2143–2152

    Article  Google Scholar 

  17. Abe Y, Matsushita M, Tada K, Yamaji K, Takasaki Y, Tamura N (2017) Clinical characteristics and change in the antibody titres of patients with anti-MDA5 antibody-positive inflammatory myositis. Rheumatology (Oxford) 56(9):1492–1497

    Article  CAS  Google Scholar 

  18. Kim J, Yoo SW, Kang SR, Bom HS, Song HC, Min JJ (2014) Clinical implication of F-18 FDG PET/CT in patients with secondary hemophagocytic lymphohistiocytosis. Ann Hematol 93(4):661–667

    Article  Google Scholar 

  19. Liang J, Sun C, Xu L, Xu G, Cao H, Lin J (2021) Community-Acquired Pneumonia and Hospital-Acquired Pneumonia in Adult Patients with Idiopathic Inflammatory Myopathy: Outcome and Antibiotic Therapy. Rheumatol Ther 8(1):255–272

    Article  Google Scholar 

  20. Yang X, Hao Y, Zhang X, Geng Y, Ji L, Li G et al (2020) Mortality of Chinese patients with polymyositis and dermatomyositis. Clin Rheumatol 39(5):1569–1579

    Article  Google Scholar 

  21. Wu C, Wang Q, He L, Yang E, Zeng X (2018) Hospitalization mortality and associated risk factors in patients with polymyositis and dermatomyositis: A retrospective case-control study. PloS One 13(2):e0192491

    Article  Google Scholar 

  22. Moghadam-Kia S, Oddis CV, Sato S, Kuwana M, Aggarwal R (2016) Anti-Melanoma Differentiation-Associated Gene 5 Is Associated With Rapidly Progressive Lung Disease and Poor Survival in US Patients With Amyopathic and Myopathic Dermatomyositis. Arthritis Care Res 68(5):689–694

    Article  CAS  Google Scholar 

  23. Danieli MG, Gambini S, Pettinari L, Logullo F, Veronesi G, Gabrielli A (2014) Impact of treatment on survival in polymyositis and dermatomyositis. A single-centre long-term follow-up study. Autoimmun Rev 13(10):1048–1054

    Article  Google Scholar 

  24. Fujisawa T, Hozumi H, Kono M, Enomoto N, Hashimoto D, Nakamura et al (2014) Prognostic factors for myositis-associated interstitial lung disease. PloS One 9(6):e98824

    Article  Google Scholar 

  25. Hajialilo M, Ghorbanihaghjo A, Khabbazi A, Kolahi S, Jafari Nakhjavani MR, Ebrahimi AA et al (2018) Long-term follow-up of 76 Iranian patients with idiopathic inflammatory myopathies. Int J Rheum Dis 21(8):1627–1633

    Article  Google Scholar 

  26. Dankó K, Ponyi A, Constantin T, Borgulya G, Szegedi G (2004) Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features: a longitudinal study of 162 cases. Medicine 83(1):35–42

    Article  Google Scholar 

  27. Yu KH, Wu YJ, Kuo CF, See LC, Shen YM, Chang HC et al (2011) Survival analysis of patients with dermatomyositis and polymyositis: analysis of 192 Chinese cases. Clin Rheumatol 30(12):1595–1601

    Article  Google Scholar 

  28. Torres C, Belmonte R, Carmona L, Gómez-Reino FJ, Galindo M, Ramos B et al (2006) Survival, mortality and causes of death in inflammatory myopathies. Autoimmunity 39(3):205–215

    Article  Google Scholar 

  29. Jin YZ, Xie MS, Yang C, Wu RL, Zhou YB, Li XM (2021) Prognostic value of peripheral blood markers in patients with myositis-associated interstitial lung diseases. Scand J Rheumatol 50(3):218–226

    Article  CAS  Google Scholar 

  30. Liang J, Cao H, Yang Y, Ke Y, Yu Y, Sun C et al (2021) Efficacy and Tolerability of Nintedanib in Idiopathic-Inflammatory- Myopathy-Related Interstitial Lung Disease: A Pilot Study. Front Med 8:626953

    Article  Google Scholar 

  31. Wong A, Callahan J, Keyaerts M, Neyns B, Mangana J, Aberle S et al (2020) 18F-FDG PET/CT based spleen to liver ratio associates with clinical outcome to ipilimumab in patients with metastatic melanoma. Cancer Imaging 20(1):36

    Article  Google Scholar 

  32. De Jaeghere EA, Laloo F, Lippens L, Van Bockstal M, De Man K, Naert E et al (2020) Splenic 18F-FDG uptake on baseline PET/CT is associated with oncological outcomes and tumor immune state in uterine cervical cancer. Gynecol Oncol 159(2):335–343

    Article  Google Scholar 

  33. Kim SY, Moon CM, Yoon HJ, Kim BS, Lim JY, Kim TO et al (2019) Diffuse splenic FDG uptake is predictive of clinical outcomes in patients with rectal cancer. Sci Rep 9(1):1313

    Article  Google Scholar 

  34. Ahn SS, Hwang SH, Jung SM, Lee SW, Park YB, Yun M et al (2017) Evaluation of Spleen Glucose Metabolism Using 18F-FDG PET/CT in Patients with Febrile Autoimmune Disease. J Nucl Med 58(3):507–513

    Article  CAS  Google Scholar 

  35. Bronte V, Pittet MJ (2013) The spleen in local and systemic regulation of immunity. Immunity 39(5):806–818

    Article  CAS  Google Scholar 

  36. Goswami RP, Haldar SN, Chatterjee M, Vij P, van der Kooi AJ, Lim J, Raaphorst J, Bhadu D, Gelardi C, Danieli MG, Kumar U (2021) Efficacy and safety of intravenous and subcutaneous immunoglobulin therapy in idiopathic inflammatory myopathy: A systematic review and meta-analysis. Autoimmun Rev 102997. Advance online publication

  37. Liang J, Cao H, Liu Y, Ye B, Sun Y, Ke Y, He Y, Xu B, Lin J (2021) The lungs were on fire: a pilot study of 18F-FDG PET/CT in idiopathic-inflammatory-myopathy-related interstitial lung disease. Arthritis Res Ther 23(1):198

    Article  CAS  Google Scholar 

Download references

Funding

This study was funded by the National Natural Science Foundation of China (Grant No. 81701602).

Author information

Authors and Affiliations

  1. PET Center, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, People’s Republic of China, 310003

    Yinuo Liu, Guolin Wang, Huatao Wang, Xin Zhao, Donghe Chen, Xinhui Su, Jing Yan & Kui Zhao

  2. Rheumatology Department, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province, People’s Republic of China, 310003

    Junyu Liang & Jin Lin

Authors
  1. Yinuo Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guolin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huatao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xin Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Donghe Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xinhui Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jing Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Junyu Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jin Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kui Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kui Zhao.

Ethics declarations

Disclosures

None.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, Y., Wang, G., Wang, H. et al. Elevated spleen FDG uptake predicts unfavorable outcome in adult idiopathic-inflammatory-myopathy patients: a crisis beyond muscles. Clin Rheumatol 41, 2103–2112 (2022). https://doi.org/10.1007/s10067-022-06111-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-022-06111-4

Keywords

Search

Navigation