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


1 Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark

2 University of Southern Denmark, Odense, Denmark

3 Department of NuclearMedicine, Odense University Hospital, Odense, Denmark



Abstract Background: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare, but well-defined syndrome com- prising 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 tomog- raphy/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-oldmalewith a history of prostate adenocarcinoma simultaneouslywith RS3PE presentedwith pain and stiff- ness 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 compatiblewith RS3PE. The patient had a previous course of RS3PE, presented as a para- neoplastic syndrome, togetherwith his prostate cancer one year earlier,which resolvedwhen the prostatic cancerwas 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. Therewas diffusely increased FDG in soft tissue around the shoulders and hips and FDG-positive axillary lymph nodes consistent with PMR. Conclusions: RS3PE and PMRmay belong to the same clinical entity. FDG-PET/CT has a potential role in themanagement of PMR as well as other rheumatic diseases.