Abstract:
A 50-year-old patient with a history of limited cutaneous scleroderma began with polyarthralgia (left shoulder, elbows and hips) without stiffness or associated inflammatory syndrome. Treatment with oral anti-inflammatory drugs was started on suspicion of peripheral spondyloarthritis with partial response. This progressed with the appearance of stiffness and functional limitation of the hips as well as an increase in the inflammatory syndrome two weeks after onset. It was decided to perform an 18F-FDG-PET scan compatible with polymyalgia rheumatica. The patient was treated with oral corticosteroids with an excellent response after one week of treatment.
CONCLUSIONS: Polymyalgia rheumatica should be considered, even in young adults, with atypical clinical presentation.Post-infectious and paraneoplastic inflammatory rheumatism should be ruled out before considering the diagnosis of polymyalgia rheumatica.18F-FDG-PET plays an important role in the positive diagnosis of PMR and in the differential diagnosis.
摘要:
一名50岁的有局限性皮肤硬皮病病史的患者开始患有多关节痛(左肩,肘部和臀部)无僵硬或相关的炎症综合征。怀疑周围性脊柱关节炎有部分反应,开始口服抗炎药治疗。这随着臀部僵硬和功能受限的出现以及发病后两周炎症综合征的增加而发展。决定进行与风湿性多肌痛兼容的18F-FDG-PET扫描。患者接受口服皮质类固醇治疗,治疗一周后反应良好。
结论:应考虑风湿性多肌痛,即使是年轻人,临床表现不典型。在考虑诊断风湿病多肌痛之前,应排除感染后和副肿瘤性炎性风湿病。18F-FDG-PET在PMR的阳性诊断和鉴别诊断中起重要作用。