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. 2021 Aug 4;5(1):31.
doi: 10.1186/s41927-021-00196-1.

Dissociation between 2-[18F]fluoro-2-deoxy-D-glucose positron emission computed tomography, ultrasound and clinical assessments in patients with non-severe rheumatoid arthritis, including remission

Charline Rinkin  1 , Pacôme Fosse  2 , Olivier Malaise  3 , Nathalie Chapelier  3 , Jil Horrion  4 , Laurence Seidel  5 , Adelin Albert  5 , Roland Hustinx  6 , Michel G Malaise  3
Affiliations

Dissociation between 2-[18F]fluoro-2-deoxy-D-glucose positron emission computed tomography, ultrasound and clinical assessments in patients with non-severe rheumatoid arthritis, including remission

Charline Rinkin et al. BMC Rheumatol. .

Abstract

Background: Inflammation of patients joints with severe disease activity of rheumatoid arthritis (RA) has already been visualized and quantified by 2-[18F]fluoro-2-deoxy-D-glucose positron emission computed tomography ([18F] FDG PET/CT), but little is known about the metabolic status and its relationship with clinical and ultrasonography (US) metrology in patients with low/moderate activity or in remission.

Methods: Clinical assessments [based on 28-joint disease activity score (DAS28-CRP) and Clinical Disease Activity Index (CDAI)], [18F] FDG PET/CT, US and X-ray were performed on 63 RA patients classified into remission or low/moderate or severe disease activity groups. PET/CT was visually and then semi-quantitatively analysed by determining the standardized uptake value (SUV) of positive joints.

Results: Of the 1764 joints, 21.1% were tender only, 13.7% swollen only, 27.6% tender or swollen, 7.3% tender and swollen, 20.5% PET/CT-positive and 8.6% US-positive. PET and US measurements were correlated, albeit with poor concordance. The positive predictive value of PET/CT for clinical evaluation (tender and/or swollen) was low, whereas its negative predictive value was high. Highly significant differences were found with the number of PET/CT-positive joints and with cumulative SUV between "severe" and "non-severe" patients (including those in remission and those with low/moderate activity) and not between those classified as "remission" and "non-remission" or "remission" and "low/moderate activity". Moreover, the correlation between PET/CT measurements and clinical activity was positive only in the CDAI severe disease group. In patients in remission or with low/moderate activity, only 20-30% of joints were PET/CT-negative. In remission, PET/CT and US were positive in different joints, and PET/CT-positive but US-negative joints mainly exhibited RA (38.1%) or normal (49.2%) and not osteoarthritic (12.7%) X-ray patterns.

Conclusions: [18F] FDG PET/CT was effective at distinguishing patients with severely active disease from other patients. In non-severe RA patients, including those in remission, PET/CT results are discordant from US and clinical observations. A longitudinal analysis is needed to explore the clinical relevance of such infra-clinical disease.

Keywords: Positron emission tomography (PET); Remission; Rheumatoid arthritis (RA); Ultrasonography (US).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Extensive inflammatory changes in several joints of the hand, along with tenosynovitis. a: MIP (maximum intensity projection) of the [18F] FDG PET image. b: CT (upper row), PET (middle row) and fused PET/CT images (lower row) in the coronal, sagittal and transaxial views, respectively. [18F] FDG PET/CT: 18F-fluorodeoxyglucose positron emission computed tomography
Fig. 2
Fig. 2
PET/CT and US positivity: distribution of the number of PET-CT-positive joints (a), cumulative SUV (b), number of US-positive joints (c), and cumulative synovial thickness (d) in 63 RA patients. PET-CT: positron emission computed tomography; US: ultrasound; SUV: standard uptake value
Fig. 3
Fig. 3
Number of PET/CT-positive joints (left panels) and CSUV (right panels) across disease activity categories based on the DAS28-CRP (upper panels) or CDAI (lower panels). PET-CT: positron emission computed tomography; CSUV: cumulative standard uptake value; DAS: disease activity score; CDAI: Clinical Disease Activity Index; CRP: C-reactive protein
See this image and copyright information in PMC

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