F-18 FDG Whole-Body PET for the Assessment of Disease Activity in Patients With Rheumatoid Arthritis

Goerres, Gerhard W.; Forster, Adrian; Uebelhart, Daniel; Seifert, Burkhardt; Treyer, Valérie; Michel, Beat A.; Schulthess, Gustav K. von; Kaim, Achim H.

doi:10.1097/01.rlu.0000222678.95218.42

Cited by 122 publications

(81 citation statements)

References 16 publications

(12 reference statements)

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“…To our knowledge, this is the first PET study in RA patients showing the potential of 18 F-FDG PET for predicting the response to infliximab therapy early in the course of treatment. Previous 18 F-FDG PET studies visualized the treatment effects of infliximab in RA patients but did not investigate the predictive value of 18 F-FDG PET for clinical response (4)(5)(6)8,9,20). In addition, various other markers have been tested, but-in line with our results-no single marker has consistently been shown to be a predictor of response to infliximab (3-6).…”

Section: Discussionsupporting

confidence: 68%

¹⁸F-FDG PET as a Tool to Predict the Clinical Outcome of Infliximab Treatment of Rheumatoid Arthritis: An Explorative Study

Elzinga¹,

Laken²,

Comans³

et al. 2010

J Nucl Med

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18 F-FDG PET is a sensitive, promising method for visualizing disease activity in rheumatoid arthritis. This study aimed to assess the association between changes in 18 F-FDG joint uptake after 2 wk of infliximab treatment and clinical outcome. Methods: Scans were obtained at the initiation of treatment and at 2 wk. Uptake in metacarpophalangeal and wrist joints was quantified using standardized uptake values. Results: Changes in mean standardized uptake value at 0-2 wk significantly correlated with the disease activity score (DAS) at 14 and 22 wk and contributed significantly to the prediction of DAS at these time points. No significant correlation was found between changes in acute-phase reactants at 0-2 wk and the DAS at later time points. Conclusion: Early changes in 18 F-FDG uptake in joints during infliximab treatment of rheumatoid arthritis patients, using PET, may predict clinical outcome. Rheumat oid arthritis (RA) is a disabling joint disease.Stringent monitoring of disease activity and, if necessary, changing to another, more effective, drug treatment has been shown to improve the outcome of patients (1).Anti-tumor necrosis factor (TNF) a-blocking agents, such as infliximab, potently bind TNF and block inflammation by inhibiting the downstream effects of this cytokine. Anti-TNF treatment is effective in reducing disease activity and improving outcome, although not in all patients (2).In general, the response to anti-TNF treatment is assessed between 14 and 22 wk after initiation of the drug. At present, there are no markers that can predict response to anti-TNF treatment at an earlier stage (3-6). Considering the high costs of anti-TNF treatment, that is, $30,500-$38,700 per discounted quality-adjusted life-year gained (7), early prediction of response could reduce the overall costs of treatment.Several reports have shown that inflammation in synovial tissue in RA patients can be detected using 18 F-FDG PET (8-12). Therefore, 18 F-FDG PET may be an interesting tool to assess response early during anti-TNF treatment.This explorative study investigated the potential ability of early 18 F-FDG PET changes to predict clinical outcome at a later stage. MATERIALS AND METHODS Patients and Study ProtocolAll patients (11 women, 5 men) fulfilled the American College of Rheumatology criteria for RA (13). The presence of at least 2 metacarpophalangeal or wrist joints with signs of arthritis was required. Patients were treated with infliximab, and infusions were administered at 0, 2, 6, 14, and 22 wk. At all time points, tenderness and swelling of proximal interphalangeal and metacarpophalangeal joints of hands, elbows, shoulders, and knees (28 joints in total) were determined. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured, and the disease activity scores (DASs) of 28 joints were calculated (14). 18 F-FDG PET scans of metacarpophalangeal and wrist joints were acquired at 0 and 2 wk. Informed consent was obtained of all participating patients. The protocol was approved by the local ...

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Section: Discussionsupporting

confidence: 68%

¹⁸F-FDG PET as a Tool to Predict the Clinical Outcome of Infliximab Treatment of Rheumatoid Arthritis: An Explorative Study

Elzinga¹,

Laken²,

Comans³

et al. 2010

J Nucl Med

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“…FDG-PET in rheumatoid arthritis and seronegative spondyloarthropathy with RA using a visual evaluation score, and concluded that FDG uptake was significantly correlated with clinical evaluations of disease activity in patients with RA before and after treatment with infliximab. Our findings are in agreement with those of Kubota et al [7] and Goerres et al [6] who also recommend the use of a FDG uptake scoring system as a useful tool in the assessment of joint inflammation. The difference between the results of Elzinga et al [14] and the other studies could be due to the use of different treatment modalities (biological vs cytoreductive) and duration of the RE scan.…”

supporting

confidence: 83%

“…The usefulness of PET using FDG-PET to assess synovial inflammation, has been evaluated by a few investigators [3][4][5][6][7] , especially in the setting of RA. Most of these studies produced promising results and were able to quantify inflammation in the joints.…”

Section: Introductionmentioning

confidence: 99%

Potential of¹⁸F-FDG-PET as a valuable adjunct to clinical and response assessment in rheumatoid arthritis and seronegative spondyloarthropathies

Vijayant

Sarma²,

Aurangabadkar³

et al. 2012

WJR

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“…They found a significant correlation between joint count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and affected joints on ultrasound, and positive joints on PET. Similarly, Goerres et al (2) Tc-glucosamine can be locally produced by a nuclear scientist in a major nuclear medicine department and administered to a patient, as one would for a bone scan, and it is easy to produce, cheap to administer, and accessible. Other similar analogs of glucosamine, such as N-[2,4,5-trihydroxy-6-(hydroxymethyl) tetrahydro-2H-pyran-3-yl] acrylamide, have been demonstrated to have anti-arthritic and immunomodulatory effects in adjuvant-induced arthritis but are yet to be tested in humans as imaging agents (9).…”

Section: Discussionmentioning

confidence: 99%

Evaluating disease activity in patients with ankylosing spondylitis and rheumatoid arthritis using 99mtc-glucosamine

Manolios

Camden

et al. 2016

Eur J Rheumatol

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Objective: To evaluate the clinical utility of a novel radiotracer, Tc-glucosamine, in assessing disease activity of both rheumatoid arthritis (RA) and ankylosing spondylitis (AS).Material and Methods: Twenty-five patients with RA (nine males and 16 females) and 12 patients with AS (all male) at various stages of disease were recruited for the study. A clinical history and examination was performed, followed by the measurement of hematological, biochemical, and autoimmune serological parameters to assess disease activity. Tc-glucosamine was intravenously administered and scans were compared with other imaging modalities, including plain X-ray, magnetic resonance imaging (MRI), and bone scans. Results: In patients with AS, 99mTc-glucosamine scans were more capable of identifying active disease and differentiating between inflammatory and non-inflammatory causes. In patients with RA, 99m Tc-glucosamine accumulated at all known sites of disease involvement. Uptake was most pronounced in patients with active untreated disease. The relative tracer activity in the involved joints increased with time compared with that in the adjoining soft tissue, liver, and cardiac blood pool. Using Spearman's correlation coefficient, there was a positive correlation among glucosamine scan scores, C-reactive protein (p=0.048), and clinical assessment (p=0.003), which was not noted with bone scans. Conclusion:The radiotracer was well tolerated by all patients, with no adverse reactions. Tc-labeled methylene diphosphonate nuclear bone scans for imaging inflamed joints and had the added advantage of demonstrating a significant clinical correlation between disease activity and scan findings.Keywords: Glucosamine, rheumatoid arthritis, ankylosing spondylitis, nuclear scan ments of cells at these sites. Tc-glucosamine can be locally produced by a nuclear scientist in a major nuclear medicine department and administered to a patient, as one would for a bone scan, and it is easy to produce, cheap to administer, and accessible. Other similar analogs of glucosamine, such as N-[2,4,5-trihydroxy-6-(hydroxymethyl) tetrahydro-2H-pyran-3-yl] acrylamide, have been demonstrated to have anti-arthritic and immunomodulatory effects in adjuvant-induced arthritis but are yet to be tested in humans as imaging agents (9).In this study, we extended our prior pilot investigations and evaluated 99m Tc-glucosamine imaging modality for its clinical utility, limitations, and applications, particularly in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Tc-glucosamine joint uptake was correlated with MRI, bone scans, and in three cases, the effect of anti-tumor necrosis factor (anti-TNF) treatment on scanning before and after therapy. Material and MethodsEthics approval All patients provided their written informed consent. The Western Sydney Local Health District Human Research Ethics Committee granted ethics approval for this study. Study populationPatients fulfilling the American College of Rheumatology revised criteria for...

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F-18 FDG Whole-Body PET for the Assessment of Disease Activity in Patients With Rheumatoid Arthritis

Abstract: Visual assessment of FDG uptake shows a significant correlation with clinical evaluation of disease activity in patients with RA undergoing antiinflammatory treatment.

Cited by 122 publications

References 16 publications

¹⁸F-FDG PET as a Tool to Predict the Clinical Outcome of Infliximab Treatment of Rheumatoid Arthritis: An Explorative Study

¹⁸F-FDG PET as a Tool to Predict the Clinical Outcome of Infliximab Treatment of Rheumatoid Arthritis: An Explorative Study

Potential of¹⁸F-FDG-PET as a valuable adjunct to clinical and response assessment in rheumatoid arthritis and seronegative spondyloarthropathies

Evaluating disease activity in patients with ankylosing spondylitis and rheumatoid arthritis using 99mtc-glucosamine

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F-18 FDG Whole-Body PET for the Assessment of Disease Activity in Patients With Rheumatoid Arthritis

Abstract: Visual assessment of FDG uptake shows a significant correlation with clinical evaluation of disease activity in patients with RA undergoing antiinflammatory treatment.

Cited by 122 publications

References 16 publications

18F-FDG PET as a Tool to Predict the Clinical Outcome of Infliximab Treatment of Rheumatoid Arthritis: An Explorative Study

18F-FDG PET as a Tool to Predict the Clinical Outcome of Infliximab Treatment of Rheumatoid Arthritis: An Explorative Study

Potential of18F-FDG-PET as a valuable adjunct to clinical and response assessment in rheumatoid arthritis and seronegative spondyloarthropathies

Evaluating disease activity in patients with ankylosing spondylitis and rheumatoid arthritis using 99mtc-glucosamine

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Product

Resources

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¹⁸F-FDG PET as a Tool to Predict the Clinical Outcome of Infliximab Treatment of Rheumatoid Arthritis: An Explorative Study

¹⁸F-FDG PET as a Tool to Predict the Clinical Outcome of Infliximab Treatment of Rheumatoid Arthritis: An Explorative Study

Potential of¹⁸F-FDG-PET as a valuable adjunct to clinical and response assessment in rheumatoid arthritis and seronegative spondyloarthropathies