Rannveig Gildberg-Mortensen

Association of Remitting Seronegative Symmetrical Synovitis with Pitting Edema, Polymyalgia Rheumatica, and Adenocarcinoma of the Prostate

Patient: Male, 83 Final Diagnosis: Remitting seronegative symmetrical synovitis with pitting edema Symptoms: Morning stiffness • pitting edema of the hands • shoulder and hip pain Medication: — Clinical Procedure: 18FDG PET/CT Specialty: Rheumatology Objective: Rare disease Background: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare condition that occurs in elderly individuals. It can present alone or in association with various rheumatic or malignant diseases. Case Report: An 83-year-old man presented with anemia, hyper-sedimentation, and pitting edema of the back of the hands. The patient complained of pain and stiffness of the shoulder and hip girdles, especially in the morning. He was previously diagnosed with adenocarcinoma of the prostate. After 3 years of watchful waiting, treatment with goserelin, a gonadotropin releasing hormone agonist, was started, when PSA had increased to 67.9 µg/l. About 1 year before the cancer treatment, the patient also presented with sore and swollen hands, compatible with RS3PE, which remitted after a few months of prostatic cancer treatment. Thorough laboratory evaluation was performed upon admission to the Rheumatology Department and he was referred for FDG PET/CT on suspicion of metastases of the previously diagnosed prostatic cancer. PET/CT imaging revealed increased FDG up-take in the soft tissues around the shoulders and hips, but no evidence of bone metastasis or other malignant findings. A diagnosis of polymyalgia rheumatica (PMR) together with RS3PE syndrome was made and treatment with prednisolone 15 mg/d was started, which resulted in rapid resolution of the symptoms. Conclusions: Presence of RS3PE in relation with PMR and prostatic cancer in our patient suggests a common trigger factor. To the best of our knowledge, this is the first report of a case of RS3PE that presented twice with 2 different diagnoses in the same patient.

Level of Adherence to Prophylactic Osteoporosis Medication amongst Patients with Polymyalgia Rheumatica and Giant Cell Arteritis: A Cross-Sectional Study.

Objective. To estimate level of adherence to oral calcium and vitamin D supplementation as well as bisphosphonate amongst patients with PMR and GCA treated with glucocorticoids. Method. A total of 138 patients with the diagnosis of PMR and/or GCA registered in our department in December 2013. In this cross-sectional study we interviewed all the patients to measure level of adherence to calcium and vitamin D, as well as bisphosphonates. Results. Out of the 118 included patients, 88.9% of them were adherent to their prescription. Only 2 patients (1.7%) did not take calcium and vitamin D at all and 10 patients (8.5%) took their medication infrequently, 9 and 1 out of 10 patients took the medication 50–100% of the time and less than 50% of the prescribed dose, respectively. Sixty-one patients received additional treatment with bisphosphonate and 96.6% were adherent to this therapy. The remaining 3.4% of the patients did not take the medication at all. Forgetfulness, adverse side effects, and lack of understanding of treatment benefits were the most significant causes for nonadherence to calcium and vitamin D. Conclusions. Contrary to what we expected this study found that adherence to osteoporosis preventive medication in patients with PMR and GCA was high.

Polymyalgia rheumatica and giant cell arteritis—three challenges—consequences of the vasculitis process, osteoporosis, and malignancy: A prospective cohort study protocol

Introduction: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are common inflammatory conditions. The diagnosis of PMR/GCA poses many challenges since there are no specific diagnostic tests. Recent literature emphasizes the ability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to assess global disease activity in inflammatory diseases. 18F-FDG PET/CT may lead to the diagnosis at an earlier stage than conventional imaging and may also assess response to therapy. With respect to the management of PMR/GCA, there are 3 significant areas of concern as follows: vasculitis process/vascular stiffness, malignancy, and osteoporosis. Methods and analysis: All patients with suspected PMR/GCR referred to the Rheumatology section of Medicine Department at Svendborg Hospital, Denmark. The 4 separate studies in the current protocol focus on: the association of clinical picture of PMR/GCA with PET findings; the validity of 18F-FDG PET/CT scan for diagnosis of PMR/GCA compared with temporal artery biopsy; the prevalence of newly diagnosed malignancies in patients with PMR/GCA, or PMR-like syndrome, with the focus on diagnostic accuracy of 18F-FDG PET/CT scan compared with conventional workup (ie, chest X-ray/abdominal ultrasound); and the impact of disease process, and also steroid treatment on bone mineral density, body composition, and vasculitis/vascular stiffness in PMR/GCA patients. Ethics and dissemination: The study has been approved by the Regional Ethics Committee of the Region of Southern Denmark (identification number: S-20160098) and Danish Data Protection Agency (J.nr 16/40522). Results of the study will be disseminated via publications in peer-reviewed journals, and presentation at national and international conferences.

Enhanced compliance to osteoporosis prophylaxis in glucocorticoid (GC)-treated polymyalgia rheumatica (PMR) patients: the role of ongoing follow-up support at nurse consultations

3 OP04 HLA-B27 status is associated with TNF-α inhibitor treatment outcomes in ankylosing spondylitis and non radiographic axial spondyloarthritis. An observational cohort study from the nationwide DANBIO registry B Glintborg, IJ Sørensen, M Østergaard, NS Krogh, AA Mohamoud, LS Andersen, JL Raun, O Hendricks, MR Kowalski, L Danielsen, SR Christensen, N Al Chaer, R Pelck, H Nordin, JK Pedersen, DGA Kraus, IMJ Hansen, J Espesen, A Schlemmer, AG Loft, L Salomonsen, L Dreyer, ML Hetland

The prevalence of pernicious anaemia, cobalamine and folic acid deficienty among patients newly diagnosed with rheumatoid arthritis: a descriptive cross-sectional study

Background: Systemic autoimmune diseases (SAIDs) affect about 0.5–1% of Europeans with a remarkable female predominance (80–90%). Present diagnostic entities are vague and rely on fairly old and un ...Citation for pulished version (APA): Lomborg, N., Just, S. A., Gildberg-Mortensen, R., Asmussen Andreasen, R., & Jensen Hansen, I. M. (2014). The prevalence of pernicious anaemia, cobalamine and folic acid deficienty among patients newly diagnosed with rheumatoid arthritis: a descriptive cross-sectional study. Scandinavian Journal of Rheumatology, 43(S127), 37. [PP140]. https://doi.org/10.3109/03009742.2014.946235Se s s i o n B 2 6 OP08/PP143 The association of fatigue, comorbidity burden, disease activity, disability, and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the QUEST-RA programme KL Grøn, L Ørnbjerg, M Hetland, T Sokka; and Quest-RA investigators 7 OP09/PP141 Fatigue fluctuates substantially in patients with stable rheumatoid arthritis treated with biological agents EL Esmose, R Cordtz, OR MadsenBackground: Patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) and increased mortality in CVD. The cause of this increase has not been completely establi ...Background: Hyaluronan (HA) is a glycosaminoglycan, mainly known for its lubricating and shock-absorbing properties in joints, present in almost every tissue in the body. Depending on its molecular ...Methotrexate in rheumatoid arthritis and psoriasis/psoriatic arthritis : a comparative study of hepatotoxicityBackground: Periarticular bone loss is an early sign of joint involvement in rheumatoid arthritis (RA) (1). Patients with RA also have an increased generalized bone loss with development of osteopo ...

Inflammation, vitamin D, and bone mineral density in patients presenting with giant cell vasculitis and/or polymyalgia rheumatica

Background: Systemic autoimmune diseases (SAIDs) affect about 0.5–1% of Europeans with a remarkable female predominance (80–90%). Present diagnostic entities are vague and rely on fairly old and un ...Citation for pulished version (APA): Lomborg, N., Just, S. A., Gildberg-Mortensen, R., Asmussen Andreasen, R., & Jensen Hansen, I. M. (2014). The prevalence of pernicious anaemia, cobalamine and folic acid deficienty among patients newly diagnosed with rheumatoid arthritis: a descriptive cross-sectional study. Scandinavian Journal of Rheumatology, 43(S127), 37. [PP140]. https://doi.org/10.3109/03009742.2014.946235Se s s i o n B 2 6 OP08/PP143 The association of fatigue, comorbidity burden, disease activity, disability, and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the QUEST-RA programme KL Grøn, L Ørnbjerg, M Hetland, T Sokka; and Quest-RA investigators 7 OP09/PP141 Fatigue fluctuates substantially in patients with stable rheumatoid arthritis treated with biological agents EL Esmose, R Cordtz, OR MadsenBackground: Patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) and increased mortality in CVD. The cause of this increase has not been completely establi ...Background: Hyaluronan (HA) is a glycosaminoglycan, mainly known for its lubricating and shock-absorbing properties in joints, present in almost every tissue in the body. Depending on its molecular ...Methotrexate in rheumatoid arthritis and psoriasis/psoriatic arthritis : a comparative study of hepatotoxicityBackground: Periarticular bone loss is an early sign of joint involvement in rheumatoid arthritis (RA) (1). Patients with RA also have an increased generalized bone loss with development of osteopo ...

Carcinoma of the prostate, RS3PE and polymyalgia rheumatica: a case study

Background: Systemic autoimmune diseases (SAIDs) affect about 0.5–1% of Europeans with a remarkable female predominance (80–90%). Present diagnostic entities are vague and rely on fairly old and un ...Citation for pulished version (APA): Lomborg, N., Just, S. A., Gildberg-Mortensen, R., Asmussen Andreasen, R., & Jensen Hansen, I. M. (2014). The prevalence of pernicious anaemia, cobalamine and folic acid deficienty among patients newly diagnosed with rheumatoid arthritis: a descriptive cross-sectional study. Scandinavian Journal of Rheumatology, 43(S127), 37. [PP140]. https://doi.org/10.3109/03009742.2014.946235Se s s i o n B 2 6 OP08/PP143 The association of fatigue, comorbidity burden, disease activity, disability, and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the QUEST-RA programme KL Grøn, L Ørnbjerg, M Hetland, T Sokka; and Quest-RA investigators 7 OP09/PP141 Fatigue fluctuates substantially in patients with stable rheumatoid arthritis treated with biological agents EL Esmose, R Cordtz, OR MadsenBackground: Patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) and increased mortality in CVD. The cause of this increase has not been completely establi ...Background: Hyaluronan (HA) is a glycosaminoglycan, mainly known for its lubricating and shock-absorbing properties in joints, present in almost every tissue in the body. Depending on its molecular ...Methotrexate in rheumatoid arthritis and psoriasis/psoriatic arthritis : a comparative study of hepatotoxicityBackground: Periarticular bone loss is an early sign of joint involvement in rheumatoid arthritis (RA) (1). Patients with RA also have an increased generalized bone loss with development of osteopo ...

SAT0171 FDG PET-CT in Polymyalgia Reumatica and Giant Cell Arteritis

Background Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory conditions of unknown etiology. They are by some authors considered as manifestations of the same disease and are both treated with corticosteroids. However, a specific diagnosis is important because of different steroid requirements, as well as the risk of vascular complications associated with GCA. Temporal artery biopsy is the gold standard for the diagnosis of GCA, although the presence of skip lesions may render the test negative. PMR is a clinical diagnosis. FDG PET-CT is a non-invasive diagnostic tool that, by using radioactive labeled fluoro-18-deoxyglucose (FDG), visualizes increased metabolic activity in both malign and inflammatory tissue including large vessel inflammation. Objectives To evaluate the contribution of PET-CT in the diagnosis of PMR and GCA. Methods Patients registered in our department in 2011-2012, who were diagnosed with PMR or GCA and at the time of diagnosis underwent PET-CT scan as well as biopsy of the temporal artery within a time span of one month were included. Biopsy was performed prior to or within a week after initiation of steroid therapy. We used kappa statistics. Results 22 patients were included (8 males,14 females). 8 had a clinical diagnosis of PMR, 10 presented with symptoms of GCA and 4 had non-specific symptoms (NSS) including fatigue, fever and high sedimentation rate, where GCA was suspected. Increased FDG-uptake in the large vessels (aorta and its main branches) was found in 10 patients. 5 of them presented with symptoms of GCA, 1 with PMR and 4 with NSS. 4 patients with symptoms of GCA had a positive biopsy, and all showed increased vascular FDG uptake. 2 patients with PMR had a positive biopsy as had 2 patients with NSS. In this agreement and reliability study the kappa coefficient was 0,63, corresponding to a substantial agreement between the biopsy and the PET findings. 1 patient had a positive biopsy and no vascular FDG uptake, whereas 3 patients showed increased vascular uptake and had a negative biopsy. We found inter-observer agreement in 82 % between PET-CT and temporal artery biopsy. Conclusions FDG PET-CT definitely has a role in the diagnosis of GCA and should be considered in patients with negative temporal artery biopsy, for the diagnosis of GCA and to rule out differential diagnosis that may mimic PMR such as malignancy. Our findings support the theory that PMR and GCA are different manifestations of the same disease. References Tanaz A Kermani et al. Polymyalgia rheumatica, Lancet 2013;381:63-72 D. Blockmans et al. New arguments for a vasculitic nature of polymyalgia rheumatica using positron emission tomography. Rheumatology 1999;38:444-447 Disclosure of Interest None Declared