Detection of clinically manifest and silent synovitis in the hands and wrists by fluorescence optical imaging

Abstract

ObjectivesThe correct identification of synovitis is critical for achieving optimal therapy results. Fluorescence optical imaging (FOI) is a novel modality based on the use of an intravenous fluorophore, which enables fluorescent imaging of the hands and wrists with increased focal optical signal intensities in areas of high perfusion and/or capillary leakage. The study objective was to determine the diagnostic utility of FOI in detecting apparent and clinically non-apparent active synovitis.MethodsBilateral hand and wrist joints (n=872) of 26 patients with inflammatory arthritis assessed by standard clinical examination, musculoskeletal ultrasound (MSUS) and FOI were studied. Synovitis was defined as tender and swollen joints on clinical examination, presence of synovial thickening and intra-articular Doppler signals on MSUS, and abnormal focal optical signal intensities on FOI, respectively. Subclinical synovitis was defined as being clinically non-apparent, but positively inflamed on MSUS.ResultsDepending on the standard used to define inflammation, FOI ranged from 73–83% sensitive and 83–95% specific for detecting manifest synovitis. For detecting clinically silent synovitis, the sensitivity, specificity and positive and negative predictive values of FOI were 80%, 96%, 77% and 97%, respectively.ConclusionsThe high degree of agreement between MSUS and FOI suggest its use in clinical practice, especially when MSUS is not available, in order to identify synovitis earlier and with greater confidence. FOI may be particularly useful in identifying patients with clinically non-apparent joint inflammation of the hands and/or wrists.

Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded, Randomized Crossover Trial

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The “green nail” phenomenon in ICG‐enhanced fluorescence optical imaging – a potential tool for the differential diagnosis of psoriatic arthritis

“…In the field of rheumatology, several studies on the Xiralite ® technology published in high‐impact journals and a number of other investigations that addressed various specific questions have provided comprehensive scientific evidence . The value of this method in various indications and situations has been examined in numerous studies and compared with clinical examination and/or other imaging procedures such as arthrosonography, power Doppler (PD) ultrasound and MRI . Given that Xiralite ® is apparently suitable to detect even minimal changes in microcirculation, it may help provide new information about the pathogenesis of the typical nail changes observed in patients with psoriasis and PsA.…”

Phänomen „grüner Nagel“ in der ICG‐gestützten fluoreszenzoptischen Bildgebung – ein möglicher differenzialdiagnostischer Hinweis auf Psoriasisarthritis

“…Mit mehreren grundlegenden, hochrangig publizierten Studien und einer ganzen Reihe von weiteren Untersuchungen zu unterschiedlichen, speziellen Fragestellungen wurde die Xiralite ® ‐Technologie im Bereich der Rheumatologie sehr umfangreich wissenschaftlich dokumentiert . Die Wertigkeit des Verfahrens bei verschiedenen Indikationen und Fragestellungen wurde in einer Vielzahl von Studien geprüft und dabei auch mit der klinischen Untersuchung und/oder anderen Bildgebungsverfahren wie Arthrosonografie, Power‐Doppler (PD)‐Sonografie und MRT verglichen . Sie scheint geeignet zu sein, sogar minimale Veränderungen der Mikrozirkulation nachzuweisen.…”