A 39-year-old woman was admitted to hospital with headaches, vomiting, psychic impairment and diplopia. Three hydatid cysts of the lung had been previously removed. An avascular mass in the left hemisphere with left-to-right displacement of the anterior cerebral arteries was noted during a brain angioscintigraphy. A computed tomography (CT) brain scan showed two cystic lesions situated in the left-frontal and occipital regions. A CT abdominal scan showed multiple cysts in the liver, spleen and both kidneys. At operation, two brain cysts were totally extirpated without rupture. The definite pathological diagnosis was secondary hydatid cysts. The headaches, vomiting and diplopia were persistent in the post-operative period. Seven days after the operation, a CT brain scan showed an infratentorial cyst. The patient rejected any surgical intervention.

BackgroundGlucocorticoids remain to be the cornerstone therapy in giant cell arteritis (GCA). However, relapses are common when the prednisone dose is tapered. Thus, additional therapies are required in relapsing GCA. The most widely used conventional immunosuppressive drug is methotrexate (MTX) which efficacy is modest. Consequently, in some cases biological therapy in needed. Among them, the most frequently used is the recombinant humanized anti-IL6 receptor antibody tocilizumab (TCZ).1 ObjectivesTo compare clinical evolution, normalization of acute phase reactants and normalization of vascular 18F-FDG uptake assessed by PET/CT in patients with GCA treated with MTX vs TCZ.MethodsComparative multicentric study of 23 patients with GCA treated with MTX vs 36 patients with GCA treated with TCZ who had a baseline and follow-up PET/CT scan. We assessed clinical improvement (no improvement/partial/complete), normalization of acute phase reactants (CRP ≤ 0.5mg/dL and/or ESR ≤ 20 mm/1st hour) and reduction of 18F-FDG uptake in PET/CT (no reduction/partial/complete normalization). Images were evaluated qualitatively by experienced nuclear medicine physicians. Prednisone tapering was also assessed. Statistical analysis was performed with SPSS. Student’s t test or Mann-Whitney U test was used to compare continuous variables, and Chi-squared test or Fisher’s exact test for categorical variables as appropriate.ResultsWe included 23 patients with GCA treated with MTX (20 women/3 men); mean age 65.6 ± 7.9 years; and 36 patients treated with TCZ (27 women/9 men); mean age 67.5 ± 8.3 years. Clinical, analytical and vascular 18F-FDG uptake evolution is shown in the TABLE. After one year of treatment, the percentage of patients who experienced complete clinical improvement was higher in those who received TCZ (88.9% vs 44.4%; p=0.003). Normalization of acute phase reactants was also more frequent in patients who received TCZ (92.6% vs 47.6%; p=0.001). In regard with reduction of vascular 18F-FDG uptake, complete normalization was only achieved in 25% of patients who received TCZ and 14.3% of those who received MTX.ConclusionPatients with GCA who received TCZ experienced a more rapid and effective clinical and analytical improvement than patients who received MTX. Besides, prednisone tapering was quicker in patients with TCZ. However, no significant differences were found in complete normalization of 18F-FDG vascular uptake between both treatments.Abstract THU0313 –Table 1Reference[1] M. Calderón-Goercke et al. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum. (2019). doi: 10.1016/j.semarthrit.2019.01.003. [Epub ahead of print])Disclosure of InterestsD. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Javier Loricera: None declared, J. Narváez Consultant for: Bristol-Myers Squibb, Elena Aurrecoechea: None declared, Ignacio Villa-Blanco: None declared, Santos Castañeda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, S...

BackgroundPolymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease of the elderly whose diagnosis is usually based on clinical and ultrasound findings. Recently, 18F-FDG PET/CT has been proposed as a promising one-step tool for assessing extent and severity of PMR. However, the pattern of 18F-FDG uptake in PMR is not well established and there is a lack of imaging guidelines.ObjectivesOur aim was to describe the musculoskeletal pattern of 18F-FDG uptake in PMR patients and assess if there were any differences between classic and atypical PMR.MethodsRetrospective study of 75 patients with PMR and their respective PET/CT scans from a referral centre. We considered two groups: a) Classic PMR: patients who fulfilled the 2012 EULAR/ACR criteria; and b) Atypical PMR: patients with symptoms resembling PMR but did not fulfil the 2012 EULAR/ACR criteria. Distributions of categorical variables were compared by Pearson Chi2 or Fisher exact test as appropriate.ResultsWe evaluated 75 patients (27 men and 48 women) with a mean age ±SD of 68.2±10.7 years. A PET/CT was performed in all of them. Forty-two (56%) patients classic PMR and 33 (44%) atypical PMR. FDG-PET uptake was observed in the following musculoskeletal regions: in shoulders (n=45), sternoclavicular joints (n=33), hips (n=32), cervical interspinous bursae (n=8), lumbar interspinous bursae (n=29), pubic symphysis (n=4), subtrochanteric bursae (n=20), ischial tuberosities (n=19) and knees (n=33). The comparative study between both groups is shown in the TABLE, without observing any statistical significance.Abstract AB1179 – Table 1# Comparisons between classic and atypical PMR.ConclusionsIn patients with PMR, 18F-FDG uptake seems to be more frequent in shoulders, sternoclavicular joints, hips and knees. In addition, 18FDG uptake can be also detected in lumbar interspinous bursae and less frequently in subtrochanteric bursae, ischial tuberosities, cervical interspinous bursae and pubic symphysis. No differences between classic and atypical PMR patients were seen.Disclosure of InterestNone declared

BackgroundGiant cell arteritis (GCA) is a large vessel vasculitis with a predisposition for the cranial branches of the external carotid artery. However, aorta and/or its main branches may also be involved (1–3.ObjectivesTo assess the vascular territories most frequently affected in a series of patients with GCA who presented extracranial vessel involvement.MethodsRetrospective study of patients with GCA who presented compromise of extracranial vessels confirmed by PET/CT. Visual analysis of vascular uptake was performed on supra-aortic trunks (SAT), aortic arch (AA), thoracic aorta (TA), abdominal aorta (AA), iliac arteries (IA), lower limb arteries (LLA), and upper limb arteries (ULA). We carried out a comparative study between both sexes to see if there was any difference in the pattern of affectation.ResultsWe evaluated 68 patients with GCA (51W/17M) with a mean age of 68.06±8.33 years. The vascular territories affected were: TA (n=58, 85.29%), SAT (n=38, 55.88%), AA (n=28, 41.18%), AA (n=18, 26.47%), LLA (n=17, 25%), IA (n=13, 19.12%) and ULA (n=6, 8.82%). We also made a study of the number of vascular territories affected: 1 vascular territory (n=13, 19.12%), 2 territories (n=22, 32.35%), 3 territories (n=18, 26.47%), 4 territories (n=12, 17.65%) and more than 4 territories (n=3, 4.41%). Likewise, a comparative study between both sexes was conducted, in which only statistical significance was achieved in the involvement of ULA, which was more frequent in men (table 1).Abstract FRI0500 – Table 1ConclusionsIn patients with GCA the involvement of TA is very frequent, followed by the SAT and the AA. To a lesser extent, the AA and the LLA vessels are affected. The involvement of the IA and the ULA vessels is less frequent; the latter more frequently in men. On the other hand, the involvement of 2–3 vascular territories are the most frequent patterns.References[1] Loricera J, Blanco R, Hernández JL, et al. Use of positron emission tomography (PET) for the diagnosis of large-vessel vasculitis. Rev Esp Med Nucl Imagen Mol. 2015;34:372–377.[2] Loricera J, Blanco R, Hernández JL, et al. Non-infectious aortitis: a report of 32 cases from a single tertiary centre in a 4-year period and literature review. Clin Exp Rheumatol. 2015;33:S19–31.[3] Loricera J, Blanco R, Hernández JL, et al. Tocilizumab in giant cella arteritis: Multicenter open-label study of 22 patients. Semin Arthritis Rheum. 2015;44:717–723.Disclosure of InterestNone declared

BackgroundFluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT has been proposed as a promising tool for assessing both musculoskeletal and vascular involvement in patients with polymyalgia rheumatica (PMR). Glucocorticoids (GC) may decrease the intensity of 18F-FDG uptake. Therefore, performance of PET/CT before steroid therapy is recommended. However, in many patients with PMR, large vessel vasculitis (LVV) is precisely suspected because of steroid resistance after a long-term treatment with GC 1.ObjectivesOur aim was to assess the influence of long-term medium-dose treatment on 18F-FDG uptake to discern if 18F FDG PET/CT could be useful to evaluate musculoskeletal and vascular involvement in patients under treatment with GC.MethodsSingle-center study of 75 patients with PMR diagnosis based on 2012 EULAR/ACR criteria. All patients underwent a PET/CT scan due to LVV suspicion based on the presence of atypical symptoms and/or persistent symptoms despite steroid therapy. We considered two groups: a) Steroid-naïve PMR patients. b) Steroid-resistant PMR patients. Both musculoskeletal and vascular 18F-FDG uptake was assessed. The statistical analysis was performed with SPSS. Student’s t test or Mann-Whitney U test was used to compare continuous variables, and Chi-squared test or Fisher’s exact test for categorical variables as appropriate.ResultsWe evaluated 75 patients, 27 men and 48 women (mean age ± SD: 68.2 ± 10.7 years). PET/CT was performed in 14 steroid-naïve PMR patients (18.7%) and 61 steroid-resistant PMR patients (81.3%). Patients under steroid treatment had received a median dose of Prednisone of 10.0 [5.0-15.0] mg/day during 9.0 [2.0-22.0] months. Vascular 18F-FDG uptake was more frequently detected in steroid-naïve patients. In regard with musculoskeletal 18F-FDG uptake, no statistically significant differences were seen between both groups (TABLE).ConclusionVascular 18F-FDG uptake detection was higher in PMR patients with LVV suspicion who had never received GC. However, PET/CT was also useful to detect vascular involvement in most of the patients under a long-term medium-dose steroid treatment.Reference[1] D. Prieto-Peña, I. Martínez-Rodríguez, J. Loricera, et al. Predictors of positive (18)F-FDG PET/CT-scan for large vessel vasculitis in patients with persistent polymyalgia rheumatica. Semin Arthritis Rheum; 2018): Doi: 10.1016/j.semarthrit.2018.05.007. [Epub ahead of print]Disclosure of InterestsD. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Isabel Martínez-Rodríguez: None declared, Jose Ignacio Banzo: None declared, Miguel A González-Gay Grant/research support from: Prof. MA Gonzalez-Gay received grants/research supports from Abbvie, MSD, Jansen and Roche., Speakers bureau: Consultation fees/participation in company sponsored speaker’s bureau from Pfizer, Lilly, Sobi, Celgene, Novartis, Roche and Sanofi., Ricardo Blanco Grant/research support from: Abbvie, MSD, and Roche, Consultant for: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Speakers bureau: Abbvie, Pfizer, Roche, Bristol...