Large vessel giant cell arteritis in remission: Is imaging useful as predictor for relapses?

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ID: 338769
2026
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Abstract
OBJECTIVE: To evaluate whether vasculitic findings (VF) on [¹⁸F] fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and/or magnetic resonance imaging (MRI) at treatment stop (TS) are associated with relapse in patients with large vessel giant cell arteritis (LV-GCA), and to explore the association between PET/CT-based polymyalgia rheumatica (PMR) findings and relapse. METHODS: LV-GCA patients included in our local GCA cohort BARK who discontinued treatment in remission and underwent PET/CT and/or MRI within ±4 months of TS were included. VF were defined using standardized criteria. Periarticular inflammation in PET/CT was scored by the Leuven score and a cut-off ≥12 was considered positive. Patients were followed for relapse. Statistics used Kaplan-Meier and Cox regression. RESULTS: VF at TS were observed in 54% of patients (25/46), including 47% of MRIs (15/32), 50% of PET/CTs (14/28), and 4/14 positive on both modalities. During follow-up, 48% (22/46) of patients relapsed in median 4.7 months after TS (82% minor, 18% major relapses). Overall, VF at TS was not associated with relapse (p = 0.1). PET/CT findings, including SUV segment/liver ratio and a modified PETVAS were not predictive for relapse (p ≥ 0.6). Absence of VF in MRI at TS was associated with relapse (p = 0.005). Six patients had positive Leuven score at TS and all relapsed (HR 5.35, 95% CI 1.70-16.83, p = 0.004). CONCLUSION: Vascular imaging at TS did not predict relapse in our cohort. There is a signal pointing towards a potential association of periarticular inflammation in PET/CT at TS to subsequent relapses, that warrants further validation.
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Authors Bruna Pitasi Arguelhes, Benedikt Schoebi, Maria Del Grande, Andrea Katharina Hemmig, Christof Rottenburger, Maurice Pradella, Markus J. Aschwanden, Daniel Staub, Christoph T. Berger, Stephan Imfeld, Gregor Sommer, Thomas D. Daikeler
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Journal international journal of rheumatology
Year 2026
DOI
10.1093/rheumatology/keag627
URL
https://doi.org/10.1093/rheumatology/keag627
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