Background/Purpose: The assessments of joint damage in patients with rheumatoid arthritis (RA) are mainly restricted to small joints in the hands and feet. However, the development of arthritis in RA patients often involves the large joints, such as the shoulder, elbow, hip, knee and ankle. Few studies have been reported regarding the degree of radiographic damage in large joints in patients with RA. 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) precisely visualizes the disease activity in large joints affected by RA. In this study, the associations between destruction of the large joints and the findings of FDG-PET/CT as well as laboratory parameters were investigated, and factors associated with large joint destruction after the administration of biological therapy were identified in patients with RA.

Methods: A total of 264 large joints in 23 RA patients (six males and 17 females; mean age of 66.9 ± 7.9 years) were assessed in this study. All patients were diagnosed according to the American College of Rheumatology criteria revised in 1987. FDG-PET/CT was performed at baseline and six months after the initiation of biological therapy. The extent of FDG uptake in large joints (shoulder, elbow, wrist, hip, knee and ankle) was analyzed using the maximum standardized uptake value (SUVmax). Radiographs of the 12 large joints per patient obtained at baseline and after two years were assessed according to Larsen’s method. A logistic regression analysis was performed to determine the factors most significantly contributing to the progression of joint destruction within two years.

Results: Among the 264 joints, radiographic progression of joint destruction was detected in 33 joints. The SUVmax at baseline and six months and the disease activity score (DAS) 28 – erythrocyte sedimentation rate (ESR) at six, 12 and 24 months were significantly higher in the group with progressive joint destruction. The SUVmax at baseline and DAS28-ESR at six months were found to be factors associated with joint destruction at two years (p < 0.05).

Conclusion: The FDG uptake in the joints with destruction was higher than that observed in the joints without destruction. The SUV max at baseline and the DAS28–ESR at six months after the biological treatment were identified to be significant factors predicting destruction of the large joints at two years.

References

Beckers C, Ribbens C, André B, et al. Assessment of disease activity in rheumatoid arthritis with (18)F-FDG PET. J Nucl Med. 2004;45(6):956-64.

Matsui T, Nakata N, Nagai S, et al. Inflammatory cytokines and hypoxia contribute to 18F-FDG uptake by cells involved in pannus formation in rheumatoid arthritis. J Nucl Med. 2009;50(6):920-6.

Okamura K, Yonemoto Y, Arisaka Y, et al. The assessment of biologic treatment in patients with rheumatoid arthritis using FDG-PET/CT. Rheumatology (Oxford). 2012;51(8):1484-91.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prediction-of-large-joint-destruction-in-patients-with-rheumatoid-arthritis-using-fdg-petct-a-prospective-study/