Abstract
A SINGLE-CENTER INVESTIGATION ON THE PREVALENCE OF MALIGNANCIES IN PATIENTS WITH POLYMYALGIA RHEUMATICA AND GIANT CELL ARTERITIS BY WAY OF 18F-FDG PET/CT: A PROSPECTIVE COHORT STUDY
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Background: Several chronic inflammatory diseases are associated with a higher risk of cancer.[1] Whether, this is the case in Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA) is still a matter of debate.
Objectives: To identify the prevalence of newly diagnosed cancers in patients with PMR and GCA by means of 18F-FDG PET/CT. Moreover, to compare the characteristics of the patients with and without cancer.
Methods: Eighty consecutive patients with newly diagnosed PMR/GCA were studied. Diagnosis of PMR/GCA was confirmed by a 40-weeks follow up. A unilateral temporal artery biopsy (TAB) was also performed at the time of diagnosis. All included patients underwent an 18F-FDG PET/CT before, or in case of GCA, within 3 days of initiation of high dose oral glucocorticoid (40-75mg). All cancer-suspicious 18F-FDG-PET/CT findings were assessed thoroughly and malignant diseases were confirmed by histology. Total PMR and GCA scores were defined as the sum of a 4-point visual grading scale in each articular/periarticular site as well as arterial segment.
Results: Of the 80 patients, 64 (83.1%) were diagnosed with pure PMR, 10 (13.0%) with concomitant GCA with PMR and 3 (3.9%) with pure GCA. Three patients were diagnosed with rheumatoid arthritis during follow up and excluded from the study. Five types of cancer in 4 (5.2%;95% CI:1.4-12.8%) patients were found. Two patients had breast cancer, one patient had adenocarcinoma of colon and one patient had adenocarcinoma of colon together with skin cancer. Besides, 4 (5.2%;95% CI:1.4-12.8%) patients had Monoclonal Gammopathy of Unknown Significance (MGUS). Age and C-reactive protein were significantly higher among those with solid cancers (p:0.049) and MGUS (p:0.017), respectively (Table1).
Table 1.
Characteristics of the patients with and without solid cancer ae well as MGUS
Variables
Cancer –,n=73
Cancer +,n=4
P-value
MGUS -, n =73
MGUS +,n =4
P-value
Age, mean±SD
71.4±7.8
79.7±7.5
0.049
71.9±8.0
70.2±9.2
0.79
Gender, n(%)
Female
46(59.7%)
3(3.9%)
0.99
47(61.0%)
2(2.6%)
0.62
Constitutional symptoms, n(%)
70(90.9%)
4(5.2%)
0.99
70(90.9%)
4(5.2%)
0.99
Shoulder girdle symptoms, n(%)
68(88.3%)
4(5.2%)
0.99
68(88.3%)
4(5.2%)
0.99
Hip girdle symptoms, n(%)
65(84.4%)
3(3.9%)
0.40
64(83.1%)
4(5.2%)
0.99
Cranial symptoms, n(%)
19(24.7%)
0(0%)
0.57
17(22.1%)
2(2.6%)
0.25
Patients pain VAS
75(50-85)
62.5(50-75)
0.53
72.5(50 -80)
87.5(77.5-95)
0.07
Patients global VAS
80(60-90)
62.5(50-75)
0.37
80(60-90)
89.5(79.5-95)
0.23
Physician global VAS
30(25-40)
24.5(20-29)
0.15
30(22.5-40)
37.5(32.5-45)
0.17
Erythrocyte sedimentation rate, mm[2-20]
54(38-79)
62.5(37.5-76)
0.93
54(38-77.5)
57.5(39 -73.5)
0.94
C-reactive protein, mg/L[<6.0]
37(17-64)
34(17.0-76)
0.80
33(17-60)
98(68 -115)
0.017
TAB positive
7(9.1%)
0(0%)
0.99
7(9.1%)
0(0%)
0.99
Total PMR score
14(10-17)
12(5-15)
0.39
14(10-17)
13(6-15.5)
0.64
Total GCA score
0(0-0)
0(0-0.5)
0.89
0(0-0)
0(0-0)
0.34
Clinical diagnosis, n(%)
0.99
0.53
Pure PMR
60(77.9%)
4(5.2%)
61(79.2%)
3(3.9%)
Pure GCA
3(3.9%)
0(0%)
3(3.9%)
0(0%)
Concomitant PMR and GCA
10(13.0%)
0(0%)
9(11.7%)
1(1.3%)
VAS: Visual analogue scale
Conclusion: The prevalence of cancers in this cohort was higher, compared to the 1-year prevalence of all cancer sites of 1.2% among age-, gender- and region-matched background population in 2016. Occult malignancies are important and relatively prevalent findings in newly diagnosed PMR/GCA patients.
REFERENCES:
[1]Hemminki K, et al. Cancer risk in hospitalized rheumatoid arthritis patients. Rheumatology (Oxford) 2008;47:698-701.
Disclosure of Interests: None declared
Citation: Ann Rheum Dis, volume 79, supplement 1, year 2020, page 681Session: Vasculitis
(Poster Presentations)
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