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. 2025 Oct 25;9(4):rkaf125.
doi: 10.1093/rap/rkaf125. eCollection 2025.

18F-FDG PET/CT discriminates whether rheumatoid arthritis patients are in ultrasound remission or not

Charline Rinkin  1 , Olivier Malaise  1 , Claire Lamaye  2 , Florane Chauveheid  1 , Caroline Gérard  1 , Laurence Seidel  3 , Michel Malaise  1 , Roland Hustinx  2 , Clio Ribbens  1
Affiliations

18F-FDG PET/CT discriminates whether rheumatoid arthritis patients are in ultrasound remission or not

Charline Rinkin et al. Rheumatol Adv Pract. .

Abstract

Objectives: 18F-FDG PET/CT is used for cancer evaluation but can also quantify joint inflammation in RA. We evaluated its ability to identify patients in remission as defined by US.

Methods: Sixty RA patients underwent clinical, PET/CT and US evaluations (hands and wrists). For PET/CT, the maximum standardized uptake value (SUVmax) was determined. At the patient level, the highest SUVmax, number of PET-positive joints and cumulative SUVmax were recorded. US evaluation included gray-scale and power Doppler.

Results: At the joint level, SUVmax was significantly lower when the joint was in US remission (P < 0.0001). Receiver operating characteristics curves identified a threshold of 0.86 to define joint remission with a high positive predictive value of 95.2%. At the patient level, the highest SUVmax and cumulative SUV were significantly lower in patients in US remission (respectively P = 0.0023 and P = 0.045). The highest SUVmax threshold of 2.36 demonstrated a high negative predictive value of 92.9% for determining US remission. For the cumulative SUVmax threshold, the negative and positive predictive values for determining US remission were both 73%. In contrast, these PET/CT parameters did not discriminate if a patient is in clinical remission or not.

Conclusions: PET/CT can identify RA patients in remission as defined by US. We show that the highest SUVmax and cumulative SUV are the two discriminative PET/CT parameters able to determine whether a patient is in US remission. This provides an additional advantage of PET/CT as an objective tool to evaluate RA.

Keywords: 18F-FDG PET/CT; remission; rheumatoid arthritis; ultrasonography.

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