The assessment of biologic treatment in patients with rheumatoid arthritis using FDG-PET/CT
ABSTRACT To evaluate whether there is a correlation between the differences in joint uptake of 2-[18F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) and the improvement of clinical findings in RA patients undergoing anti-TNF therapies.
Twenty-two patients who received anti-TNF therapies, including infliximab for 16 patients and etanercept for 6 patients, were assessed. PET with (18)F-FDG studies and clinical assessments were performed at baseline and 6 months after the initiation of therapy. The maximal standardized uptake value (SUV(max)) was used as a representative value for the assessment of the FDG uptake in the bilateral shoulder, elbow, wrist, hip, knee and ankle joints. Spearman's rank correlation test was applied to assess the correlation between the SUV and the clinical parameters.
The ΔSUV (12 joints), the difference in the SUV(max) of the affected 12 joints before and after treatment, was positively correlated with the ΔDAS28 (r = 0.609, P = 0.003), ΔDAS28-CRP (r = 0.656, P = 0.001) and Δtender joint count (TJC) (r = 0.609, P = 0.003). There were also significantly positive correlations between ΔSUV (8 joints); the difference in the SUV(max) of the bilateral shoulder, elbow, wrist and knee joints before and after treatment and the ΔDAS28 (r = 0.642, P = 0.001), ΔDAS28-CRP (r = 0.712, P < 0.001) and ΔTJC (r = 0.608, P = 0.003), respectively.
The FDG uptake observed in the inflamed RA joints may reflect disease activity. The FDG-PET response was correlated with the clinical response to the biologic treatment of RA.
SourceAvailable from: Hiroyuki Yamashita[Show abstract] [Hide abstract]
ABSTRACT: Advanced imaging techniques may enable early diagnosis and monitoring of therapy in various rheumatic diseases. To prevent irreversible tissue damage, inflammatory rheumatic disease must be diagnosed and treated in pre-clinical stages, requiring highly sensitive detection techniques. Positron emission tomography (PET) provides highly sensitive, quantitative imaging at a molecular level, revealing the important pathophysiological processes underlying inflammation. This review provides an overview of the current utility of 18 F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in patients with active rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, polymyalgia rheumatica, adult-onset Still's disease, relapsing polychondritis, immunoglobulin G4-related disease, large-vessel vasculitis, Wegener's granulomatosis, polymyositis, and dermatomyositis. We also discuss the role of FDG-PET/CT in the diagnosis and monitoring of these diseases.Arthritis Research & Therapy 08/2014; 16(5):423. DOI:10.1186/s13075-014-0423-2 · 4.12 Impact Factor
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ABSTRACT: Introduction: Rheumatoid arthritis (RA) is a disease characterized by inflammation of the synovial membrane. Several authors have investigated the role of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (18F-FDG) in RA. Objectives: To systematically review the current literature on the role of 18F-FDG PET in the diagnosis, determination of disease activity and assessment of treatment response in patients with RA. Methods: Searches were conducted in Medline, Cochrane Library, Lilacs, Pubmed and Scopus in Portuguese, English and Spanish languages, using the keywords rheumatoid arthritis, synovitis, FDG, PET, glycolytic metabolisrm and disease activity. Results: 142o articles were initially identified, of which only 40 were related directly to the subject. Twelve original articles and three case reports that met the inclusion criteria were selected. Discussion: The presence of activated macrophages and fibroblasts in pannus are responsible for the intense periarticular uptake of 18F-FDG. The uptake patterns do not allow the differential diagnosis with other arthritides. The uptake intensity and the number of joints involved are metabolic parameters of disease activity that correlate well with the composite indices. Longitudinal studies of PET have proven useful in assessing the response to treatment with anti-TNF. When performed early, PET can predict the therapeutic response. Conclusion: Although the actual role of this new technique for the investigation of RA is not yet established, 18F-FDG PET is a promising tool in determining the activity and prediction of response to treatment of patients with RA. (c) 2014 Elsevier Editora Ltda. All rights reserved.10/2014; 54(6). DOI:10.1016/j.rbre.2014.07.003
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ABSTRACT: Positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (18F-FDG) can detect the presence of synovitis in rheumatoid arthritis (RA) patients. The aim of this study was to investigate whether the findings of FDG-PET matched the conventional assessments of the disease activity score (DAS) 28, DAS28-CRP, simplified disease activity index (SDAI) and clinical disease activity index (CDAI) in RA patients receiving tocilizumab (TCZ) therapy. Seventeen RA patients treated with TCZ were assessed. FDG-PET was performed at baseline and three and six months after the initiation of TCZ therapy. The maximum SUV (SUVmax) of the bilateral shoulder, elbow, wrist, hip, knee and ankle joints were added together (total SUV) and were used to assess the degree of FDG uptake as a representative parameter. The correlations between the DeltaSUV and the difference in the clinical parameters at baseline and at each observation period, and the differences in each clinical parameters, were assessed. The DeltaSUV, the differences in the total SUV at baseline and at three/six months after starting treatment positively correlated with the DeltaDAS28 (r = 0.615 p = 0.009/ r = 0.775 p < 0.001), DeltaDAS28-CRP (r = 0.696, p = 0.002/ r = 0.828, p < 0.001), DeltaSDAI (r = 0.652, p = 0.005/ r = 0.686, p = 0.002) and DeltaCDAI (r = 0.662, p = 0.004/ r = 0.711, p = 0.001) for each period. The total SUV was significantly decreased at three and six months after the initiation of TCZ (p < 0.05). A reduction in the FDG uptake was observed at three and six months after the initiation of TCZ therapy. The disease activity estimated on FDG-PET/CT matched the conventional parameters following the TCZ therapy in RA patients.BMC Musculoskeletal Disorders 11/2014; 15(1):393. DOI:10.1186/1471-2474-15-393 · 1.90 Impact Factor