This article is part of the Topical Collection on Infection and Arthritis
Fever is common within rheumatology but it is often challenging to identify its source. To do so correctly is paramount in patients with an underlying inflammatory condition receiving immunosuppressive therapy. This review article looks at the available evidence and merits of both 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans and new proposed biomarkers in determining the cause of fever within rheumatology.
18F-FDG PET/CT scans are already an established tool in the detection and diagnosis of malignancy and are emerging for use in fever of unknown origin. More recently, they have been used to identify rheumatological causes of fever such as large vessel vasculitis and adult-onset Still’s disease. Within these conditions, biomarkers such as procalcitonin and presepsin may help to differentiate endogenous from exogenous pyrogens.
18F-FDG PET/CT scanning shows promise in locating the source of pyrogens and may be superior to other conventional forms of imaging. As evidence and test availability increases, its use is likely to become commonplace in the diagnostic work-up of fever. Once a source is located, selected biomarkers may be used to confirm a cause.
Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine. 1961;40:1–30. CrossRef
Durack DT, Street AC. Fever of unknown origin – reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35–51. PubMed
Bleeker-Rovers CP, Vos FJ, de Kleijn EM, et al. A prospective multi-centre study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine. 2007;86:26–38. CrossRef
Schönau V, Vogel K, Englbrecht M, et al. The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study. Ann Rheum Dis. 2018;77:70–7. CrossRef
Delbeke D, Martin WH. Positron emission tomography imaging in oncology. Radiol Clin N Am. 2001;39(5):883–917. CrossRef
Kouijzer IJ, Bleeker-Rovers CP, Oyen WJ. FDG-PET in fever of unknown origin. Semin Nucl Med. 2013;43:333–9. CrossRef
Becker W, Meller J. The role of nuclear medicine in infection and inflammation. Lancet Infect Dis. 2001;1(5):326–33. CrossRef
• Bharucha T, Rutherford A, Skeoch S, et al. Diagnostic yield of FDG-PET/CT in fever of unknown origin: a systematic review, meta-analysis and dephi exercise. Clin Radiol. 2017. Available from: 10.1016/j.crad.2017.04.014 [Accessed 22nd January 2018]. This systematic review evaluates available evidence for the use of FDG-PET/CT in fever of unknown origin and discusses cost vs. benefits.
• Imfeld S, Rottenburger C, Schegk E, et al. [18F] FDG positron emission tomography in patients presenting with suspicion of giant cell arteritis – lessons from a vasculitis clinic. Eur Heart J Cardiovasc Imaging. 2017. This article evaluates the value of FDG-PET/CT in giant cell arteritis and discusses where false positive results may be obtained.
Meller J, Sahlmann CO, Scheel AK. 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med. 2007;48(1):35–45. PubMed
Clifford A, Burrell S, Hanly JG. Positron emission tomography/computed tomography for the diagnosis and assessment of giant cell arteritis: when to consider it and why. J Rheumatol. 2012;39:1909–11. CrossRef
Myklebust G, Gran JT. A prospective study of 287 patients with polymyalgia rheumatic and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis’. Br J Rheumatol. 1996;35:1161–8. CrossRef
Hall S, Barr W, Lie JT, et al. Takayasu arteritis. A study of 32 North American patients. Medicine. 1985;64:89–99. CrossRef
Treglia G, Mattoli MV, Leccisotti L, et al. Usefulness of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography in patients with large-vessel vasculitis: a systematic review. Clin Rheumatol. 2011;30(10):1265–75. CrossRef
Ergül N, Cermik TF. FDG-PET or PET/CT in fever of unknown origin: the diagnostic role of underlying primary disease. Int J Mol Imaging. 2011;3:2011.
Chong EW, Robertson AJ. Is temporal artery biopsy a worthwile procedure? ANZ J Surg. 2005;75(6):388–91. CrossRef
Soussan M, Nicolas P, Schramm C, et al. Management of large-vessel vasculitis with FDG-PET: a systematic literature review and meta-analysis. Medicine. 2015;94(14):e622. CrossRef
• Grayson PC, Alehashemi S, Bagheri AA, et al. Positron emission tomography as an imaging biomarker in a prospective longitudinal cohort of patients with large vessel vasculitis. Arthritis Rheum. 2017. https://doi.org/10.1002/art.40379 This study evaluates the use of FDG-PET/CT in patients with large vessel vasculitis as compared to patients with vasculitis mimics. CrossRef
Glaudemans AW, de Vries EF, Galli F, et al. The use of F-FDG-PET/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases. Clin Dev Immunol. 2013
Galloway J, Cope AP. The ying and yang of fever in rheumatic disease. Clin Med. 2015;15(3):288–91. CrossRef
Yamashita H, Kubota K, Takahashi Y, et al. Clinical value of 18F-fluoro-deoxyglucose positron emission tomography/computed tomography in patients with adult-onset Still’s disease: a seven-case series and review of the literature. Mod Rheumatol. 2014;24(4):645–50. CrossRef
Dong MJ, Wang CQ, Zhao K, et al. 18F-FDG PET/CT in patients with adult-onset Still’s disease. Clin Rheumatol. 2015;34(12):2047–56. CrossRef
Firooz N, Albert DA, Wallace DJ, et al. High-sensitivity C-reactive protein and erythrocyte sedimentation rate in systemic lupus erythematosus. Lupus. 2011;20:588–97. CrossRef
Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011;9:197. CrossRef
Shaikh MM, Hermans LE, van Laar JM. Is serum procalcitonin measurement a useful addition to a rheumatologist’s repertoire? A review of its diagnostic role in systemic inflammatory diseases and joint infections. Rheumatology. 2014;54(2):231–40. CrossRef
Scire CA, Cavagna L, Perotti C, et al. Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases. Clin Exp Rheumatol. 2006;24:123–8. PubMed
Shen CJ, Wu MS, Lin KH, et al. The use of procalcitonin in the diagnosis of bone and joint infections: a systemic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2013;32:807–14. CrossRef
Sato H, Tanabe N, Murasawa A, et al. Procalcitonin is a specific marker for detecting bacterial infection in patients with rheumatoid arthritis. J Rheumatol. 2012;39(8):1517–23. CrossRef
Kim HA, Jeon JY, An JM, et al. C-reactive protein is a more sensitive and specific marker for diagnosing bacterial infections in systemic lupus erythematosus compared to S100A8/A9 and procalcitonin. J Rheumatol. 2012;39(4):728–34. CrossRef
Tamaki K, Kogata Y, Sugiyama D, et al. Diagnostic accuracy of serum procalcitonin concentrations for detecting systemic bacterial infection in patients with systemic autoimmune diseases. J Rheumatol. 2008;35(1):114–9. PubMed
Zou Q, Wen W, Zhang XC. Presepsin as a novel sepsis biomarker. World J Emerg Med. 2014;5:16–9. CrossRef
Endo S, Suzuki Y, Takahashi G, et al. Presepsin as a powerful monitoring tool for the prognosis and treatment of sepsis; a multicenter prospective study. J Infect Chemother. 2014;20:30–4. CrossRef
• Tsujimoto K, Hata A, Fujita M, et al. Presepsin and procalcitonin as biomarkers of systemic bacterial infection in patients with rheumatoid arthritis. Int J Rheum Dis. 2016. This article compares the use of presepsin and procalcitonin in patients with rheumatoid arthritis and systemic infection.
Tsuji S, Kitatoube A, Kikuchi-Taura A, et al. Elevated soluble CD14-subtype (PRESEPSIN; P-SEP) levels in rheumatoid arthritis (RA) patients with bacterial infection. Mod Rheumatol. 2017;27(4):718–20. CrossRef
• Ettinger M, Calliess T, Kielstein JT, et al. Circulating biomarkers for discrimination between aseptic joint failure, low-grade infection, and high-grade septic failure. Clin Infect Dis. 2015;61(3):332–41 This article compares different biomarkers in aseptic vs. septic joint pathology and concludes that combinations of biomarkers are superior to any one alone. CrossRef
Buttaro MA, Tanoira I, Comba F, et al. Combining C-reactive protein and interleukin-6 may be useful to detect periprosthetic hip infection. Clin Orthop Relat Res. 2010;468:3263–7. CrossRef
- Differentiating Disease Flare From Infection: A Common Problem in Rheumatology. Do 18F-FDG PET/CT Scans and Novel Biomarkers Hold The Answer?
- Springer US
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II