18
F fluorodeoxyglucose (
18
F-FDG) positron emission tomography (PET) can be used to image synovial inflammation in patients with rheumatoid arthritis (RA). Recently, clinical application of novel therapies for RA, such as tumor necrosis factor-α (TNF-α) inhibitor and anti-interleukin-6 receptor antibody, has been introduced. The radiological assessment of disease activity changes of patients who underwent these therapies will help the clinicians to obtain more information about the patients and to decide drug withdrawal or change of medication. It is considered that
18
F-FDG PET scan is generally very expensive; however, the information from
18
F-FDG PET about patients during biological treatments helps discontinuation of these treatments with incomplete response despite its high costs and with possible side effects such as malignant lymphoma. In this study, we evaluated if the 18F-FDG uptake of the affected joints represented by standardized uptake value (SUV) correlated with the clinical assessment of patients with RA. In addition, we would like to evaluate if there was a correlation between the difference of SUV and improvement of clinical findings in RA patients undergoing anti TNF therapies. RA patients who underwent anti-TNFα therapies in a tertiary care hospital were assessed using whole-body
18
F-FDG PET/computed tomography (CT). PET assessments were performed on hip joints, knees, shoulders, wrists, ankles, MCP, and PIP for a total of 28 joints in each patient. The
18
F–FDG uptake was then quantified using the maximum SUV (SUVmax) prior to, and 6 months after the initiation of treatment with anti-TNF-α drugs. Disease activity score (DAS28 and DAS28-C-reactive protein [CRP]) were recorded and white blood cell, matrix metalloproteinases (MMP-3) and rheumatoid factor (RF) were examined in all patients. The average of SUV
max
among measured joints, or the sum of these joints (total SUV
max
), correlated with DAS28 (
r
= 0.671,
P
< 0.001), DAS28-CRP (
r
= 0.623,
P
< 0.001), ESR (
r
= 0.542,
P
< 0.001), CRP (
r
= 0.411,
P
= 0.002), MMP-3 (
r
= 0.399,
P
= 0.006), and RF (
r
= 0.447,
P
= 0.002). There were correlations between ΔSUV and ΔDAS28 (
r
= 0.651,
P
< 0.001), ΔSUV and ΔDAS28-CRP (
r
= 0.682,
P
< 0.001), ΔSUV and ΔESR (
r
= 0.449,
P
= 0.023), and ΔSUV and ΔMMP-3 (
r
= 0.457,
P
= 0.027), respectively. The number of PET-positive joints and the cumulative SUV significantly corre...