Demonstrating disease activity in patients with rheumatoid arthritis

Summary

Aim: We aimed to investigate the relationship of fluor-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F FDG PET/CT) with clinical, laboratory parameters and conventional radiographs in patients with rheumatoid arthritis (RA). Patients, material, methods: 25 patients with RA diagnosis were evaluated by sociodemographic, clinical [duration of disease (year), the joints in which the complaints started, most recent joint involvement]; other parameters used in RA-specific clinical assessment [Steinbocker functional staging, disease activity score 28 (DAS 28 score), health assessment questionnaire score (HAQ score), general RA assessment (patients’ and physicians’ global assessment), patients’ assessments of pain and general health condition (visual analog scale)], laboratory, radiological [conventional radiology of hand and foot joints], positron emission tomography [¹⁸F FDG PET visual total score and maximum standardized uptake value (SUVmax) total score] parameters. Results: No significant correlation was detected between the ¹⁸F FDG PET total score and SUVmax total score of the patients and clinical, laboratory, and radiological parameters (p > 0.05). There was no relationship between the cut-off values determined according to the disease activity and ¹⁸F FDG PET/ SUVmax total values (p > 0.05). Conclusions: In our study, no relationship was found between disease activity demonstrated by ¹⁸F FDG PET/CT in RA patients and clinical, laboratory, and radiological parameters. ¹⁸F FDG PET/CT appears to be a more sensitive method in demonstrating disease activity compared to other evaluated methods.

Zusammenfassung

Ziel: Bei dieser Studie wurde die Beziehung der Klinik und Laborparameter mit der konventionellen Radiographie von ¹⁸F-FDG-PET/ CT bei Patienten mit rheumatoider Arthritis (RA) erforscht. Patienten, Material, Methode: Bei 25 Patienten mit der Diagnose RA wurden soziodemographische Daten, klinische Daten [Dauer der Erkrankung (in Jahren), Gelenke, bei denen die Beschwerden begannen, Gelenke, die zuletzt betroffen wurden], andere Parameter [Steinbocker funktionelle Kapazität, Punktzahl 28 der Erkrankungsaktivität (DAS-28-Score), die bei der klinischen Bewertung bei RA-Patienten angewandt werden, der Gesundheits-Auswertungsfragebogen HAQ-Score, die Daten der allgemeinen RABeurteilung (globale Beurteilung des Patienten und des Arztes); die Beurteilung der Schmerzen von seitens des Patienten (visuelle analoge Skala: 0 sehr gut – 10 sehr schlecht)], Laboratorium, Radiologie (konventionelle Radiographie der Hand und Fußgelenke) und die Daten der Positronenemissionstomographie (FDG PET totaler score und SUVmax totaler score) beurteilt. Ergebnisse: Zwischen PET- und SUVmax-Gesamt-Score, Klinik, Labor- und Radiologieparametern wurde keine bedeutsame Korrelation festgestellt (p > 0.05). Schlussfolgerung: Bei unserer Studie wurde zwischen ¹⁸F-FDG-PET/CT, dargestellter Erkrankungsaktivität von RA-Patienten Klinik, Labor- und Radiologieparametern keine bedeutsame Beziehung festgestellt. ¹⁸F-FDG-PET/CT scheint bei Patienten mit rheumatoider Arthritis zur Beurteilung der Erkrankungsaktivität eine sensiblere Methode zu sein als die anderen Methoden.

Keywords

¹⁸F FDG PET/CT - rheumatoid arthritis - disease activity - DAS 28 - SUVmax

Schlüsselwörter

¹⁸F FDG PET/CT - rheumatoide Arthritis - Krankheitsaktivität - DAS 28 - SUVmax

• References

• 1 Andersson I, Marsal L, Nilsson B. et al. Abnormal axillary lymph nodes in rheumatoid arthritis. Acta Radiol Diagn (Stockh) 1980; 21: 645-649.
• 2 Arnett FC, Edworthy SM, Bloch DA. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-324.
• 3 Backhaus M, Kamradt T, Sandrock D. et al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999; 42: 1232-1245.
• 4 Beckers C, Jeukens X, Ribbens C. et al. ¹⁸F-FDG PET imaging of rheumatoid knee synovitis correlates with dynamic magnetic resonance and sonographic assessments as well as with the serum level of metalloproteinase-3. Eur J Nucl Med Mol Imaging 2006; 33: 275-280.
• 5 Beckers C, Ribbens C, André B. et al. Assessment of disease activity in rheumatoid arthritis with ¹⁸F-FDG PET. J Nucl Med 2004; 45: 956-964.
• 6 Boutry N, Morel M, Flipo RM. et al. Early rheumatoid arthritis: a review of MRI and sonographic findings. AJR Am J Roentgenol 2007; 189: 1502-1509.
• 7 Bresnihan B. Pathogenesis of joint damage in rheumatoid arthritis. J Rheumatol 1999; 26: 717-719.
• 8 Calgüneri M, Oztürk MA, Ozbalkan Z. et al. Frequency of lymphadenopathy in rheumatoid arthritis and systemic lupus erythematosus. J Int Med Res 2003; 31: 345-349.
• 9 Dreher R. Origins of synovial type A cells during inflammation. Immunobiology 1982; 161: 232.
• 10 Forslind K, Ahlmen M, Eberhardt K. et al. Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti-CCP). Ann Rheum Dis 2004; 63: 1090-1095.
• 11 Goerres GW, Forster A, Uebelhart D. et al. ¹⁸F FDG whole-body PET for the assessment of disease activity in patients with rheumatoid arthritis. Clin Nucl Med 2006; 31: 386-390.
• 12 Harris ED. Clinical features of rheumatoid arthritis. In: Ruddy S, Harris ED, Sledge CB. (eds). Kelley’s textbook of rheumatology. Philadelphia: WB. Saunders Company; 2001: 967-1000.
• 13 Hulsmans HM, Jacobs JW, van der Heijde DM. et al. The course of radiologic damage during the first six years of rheumatoid arthritis. Arthritis Rheum 2000; 43: 1927-1940.
• 14 Kaim AH, Weber B, Kurrer MO. et al. Autoradiographic quantification of ¹⁸F-FDG uptake in experimental soft-tissue abscesses in rats. Radiology 2002; 223: 446-451.
• 15 Kubota K, Ito K, Morooka M. et al. Whole-body FDG-PET/CT on rheumatoid arthritis of large joints. Ann Nucl Med 2009; 23: 783-791.
• 16 Kubota K, Ito K, Morooka M. et al. FDG PET for rheumatoid arthritis: basic considerations and whole-body PET/CT. Ann NY Acad Sci 2011; 1228: 29-38.
• 17 Kücükdeveci AA, Sahin H, Ataman S. et al. Issues in crosscultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum 2004; 51: 14-19.
• 18 Minaker K, Little H. Painful feet in rheumatoid arthritis. Can Med Assoc J 1973; 20 109: 724-725.
• 19 Moon YL, Lee SH, Park SY. et al. Evaluation of shoulder disorders by 2-[¹⁸F]-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography. Clin Orthop Surg 2010; 2: 167-172.
• 20 O’Dell JR. Rheumatoid arthritis: the clinical picture. In: Koopman WJ. (ed). Arthritis and allied conditions. Philadelphia: Lippincott Williams and Wilkins; 2001: 1153-1186.
• 21 Ostendorf B, Scherer A, Mödder U. et al. Diagnostic value of magnetic resonance imaging of the forefeet in early rheumatoid arthritis when findings on imaging of the metacarpophalangeal joints of the hands remain normal. Arthritis Rheum 2004; 50: 2094-2102.
• 22 Ostergaard M, Stoltenberg M, Løvgreen-Nielsen P. et al. Quantification of synovistis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation. Magn Reson Imaging 1998; 16: 743-754.
• 23 Palmer WE, Rosenthal DI, Schoenberg OI. et al. Quantification of inflammation in the wrist with gadolinium-enhanced MR imaging and PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 1995; 196: 647-655.
• 24 Polisson RP, Schoenberg OI, Fischman A. et al. Use of magnetic resonance imaging and positron emission tomography in the assessment of synovial volume and glucose metabolism in patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 819-825.
• 25 Prevoo ML, van’t Hof MA, Kuper HH. et al. Modified disease activity scores that include twentyeight- joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 44-48.
• 26 Seldin DW, Habib I, Soudry G. Axillary lymph node visualization on F-18 FDG PET body scans in patients with rheumatoid arthritis. Clin Nucl Med 2007; 32: 524-526.
• 27 Serdaroglu M, Cakirbay H, Deger O. et al. The association of anti-CCP antibodies with disease activity in rheumatoid arthritis. Rheumatol Int 2008; 28: 965-970.
• 28 Steinbrocker O, Traeger CH, Batterman RC. Therapeutic criteria for rheumatoid arthritis. JAMA 1949; 140: 659-666.
• 29 Tateishi U, Imagawa T, Kanezawa N. et al. PET assessment of disease activity in children with juvenile idiopathic arthritis. Pediatr Radiol 2010; 40: 1781-1788.
• 30 Turner DE, Helliwell PS, Emery P. et al. The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskelet Disord 2006; 7: 102.
• 31 Van Riel PL, Fransen J. Established rheumatoid arthritis: clinical assessments. Best Pract Res Clin Rheumatol 2007; 21: 807-825.