Regional Lymph node hypermetabolism corresponding to the involved joints on FDG-PET in newly diagnosed patients of rheumatoid arthritis: observation and illustration in symmetrical and asymmetric joint involvement

Excerpt

Specific pattern of lymph node hypermetabolism on FDG-PET in 2 newly diagnosed RA patients with symmetrical and asymmetric joint involvement is illustrated in this communication. In our own experience as well as of others [1‐2], these nodes do not harbour malignancy. One of the patients was a 55-year-old female presented with joint pain and swelling of both lower limbs and left upper limb (with sparing of the right upper limb joints) along with morning stiffness, and the other, a 62-year-old female, had involvement of bilateral wrist and knee joints and left-sided elbow joint. The serum anti-cyclic citrullinated protein antibodies were strongly positive in both the patients (>300 EU). Whole-body FDG-PET in the first patient, in addition to uptake in the hypermetabolic joints corresponding to the clinical involvement, demonstrated intense FDG activity in the left axillary nodes and bilateral inguinal nodes (Fig. 1, arrows) and, interestingly, no hypermetabolism in the right axillary nodes (commensurate with the absence of the right upper limb joint involvement). In the second patient, high FDG activity was observed in the supratrochlear, axillary, popliteal and inguinal lymph nodes as well as the clinically palpable subcutaneous nodule on left upper limb (arrows) (Fig. 2).

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