18F-sodium fluoride PET-CT visualizes both axial and peripheral new bone formation in psoriatic arthritis patients

Abstract

Purpose: As bone formation is associated with psoriatic arthritis (PsA), positron emission tomography (PET) using a ¹⁸F-Fluoride tracer may enable sensitive detection of disease activity. Our primary aim was to determine the feasibility of whole-body ¹⁸F-sodium fluoride PET-CT in clinically active PsA patients to depict new bone formation (as a reflection of disease activity) at peripheral joints and entheses. Our secondary aim was to describe ¹⁸F-sodium fluoride findings in the axial skeleton.

Methods: Sixteen patients (female 10/16, age 50.6 ± 8.9 years) with PsA fulfilling CASPAR criteria or with a clinical diagnosis of PsA according to the treating rheumatologist and with ≥ 1 clinically active enthesitis site were included. Of each patient, a whole-body ¹⁸F-sodium fluoride PET-CT scan was performed. All scans were scored for PET-positive lesions at peripheral joints, enthesis sites and the spine. Clinical disease activity was assessed by swollen/tender joint count 44, enthesitis according to MASES and SPARCC scores.

Results: Out of 1088 evaluated joints, 109 joints showed PET enhancement, mainly in the interphalangeal and metatarsal joints of the feet (14/109, 12.9%) and the distal interphalangeal joints of the hands (14/109, 12.9%). PET positivity was found at 44/464 enthesis sites, mainly at the patella tendon insertion (11/44, 25%) and quadriceps tendon insertion (10/44, 22.7%). Of the PET-positive joints and enthesis sites, respectively 18.2% and 29.5% were clinically positive; 81.8% and 70.5% of the PET-positive joints and entheses respectively were clinically asymptomatic. In 11 patients, ≥ 1 axial PET-positive lesion was observed, mainly in the cervical spine.

Conclusions: New molecular bone formation was observed on ¹⁸F-sodium fluoride PET-CT scans, in all domains in which PsA disease activity can be observed, with a substantial part showing no clinical symptoms.

Clinical trial registration: EudraCT: 2017-004,850-40, registered on 13 December 2017.

Keywords: 18F-sodium fluoride PET/CT; Bone formation; Feasibility; Psoriatic arthritis.

Fig. 1

¹⁸F-NaF enhancement in the right wrist and proximal interphalangeal joints of the hands (A), at the patella tendon insertion (B), in the metatarsophalangeal and interphalangeal joints of the feet and the right Achilles tendon (C) and in the distal interphalangeal joints of the hands (D)

Fig. 2

¹⁸F-NaF enhancement in the thoracic spine, at the anterior side of vertebrae and at a costovertebral joint (A, B) and in the left sacroiliac joint (C)