FDG-PET/CT Findings in a Patient with Polymyalgia Rheumatica and Accompanying Remitting Seronegative Symmetrical Synovitis with Pitting Edema

Abstract

Background: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare, but well-defined syndrome comprising polyarthritis with symmetrical synovitis of the small joints in hands and feet accompanied by marked pitting edema. It is often considered a paraneoplastic syndrome, but here we report a case with F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) findings of polymyalgia rheumatica (PMR) in a patient with RS3PE and suspected of paraneoplastic syndrome. Objectives: To briefly report the potential of FDG-PET/CT in rheumatic settings. Methods: An 83-year-old male with a history of prostate adenocarcinoma simultaneously with RS3PE presented with pain and stiffness of the shoulder and hip girdles to the department of rheumatology. He was anemic and had hypersedimentation of 106. He also complained of sore and swollen hands compatible with RS3PE. The patient had a previous course of RS3PE, presented as a paraneoplastic syndrome, together with his prostate cancer one year earlier, which resolved when the prostatic cancer was in remission. FDG-PET/CT was performed due to suspicion of repeat paraneoplastic syndrome. Results: FDG-PET/CT findings showed no evidence of malignant disease. There was diffusely increased FDG in soft tissue around the shoulders and hips and FDG-positive axillary lymph nodes consistent with PMR. Conclusions: RS3PE and PMR may belong to the same clinical entity. FDG-PET/CT has a potential role in the management of PMR as well as other rheumatic diseases.