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Abstract Number: 0452

Total-Body 18F-FDG PET/CT Imaging: A Tool for Diagnosis and Quantifying Inflammatory Burden of Psoriatic Arthritis

Siba Raychaudhuri1, Yasser Abdelhafez2, Smriti Kundu-Raychaudhuri2 and Abhijit Chaudhari2, 1Sacramento Veterans Affairs Medical Center (VAMC)/University of California-Davis Health, Davis, CA, 2UC Davis School of Medicine, Davis, CA

Meeting: ACR Convergence 2021

Keywords: Diagnostic test, Imaging, Psoriatic arthritis

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Session Information

Date: Saturday, November 6, 2021

Session Title: Abstracts: Spondyloarthritis Including PsA – Diagnosis, Manifestations, & Outcomes I (0449–0452)

Session Type: Abstract Session

Session Time: 10:15AM-10:30AM

Background/Purpose: The underlying pathology in psoriatic arthritis (PsA) is systemic inflammation. The Total Body (TB)-PET/CT with the 18F-FDG radiotracer captures glucose metabolism across the entire body, and provides standardized measures as surrogates for degree of inflammation such as SUVmax. So, we predicted that these TB-PET/CT indices will correlate with the existing outcome measures of the 5 clinical domains of PsA (DAPSA, Leeds Enthesitis Index, Leeds Dactylitis Index, BASDAI and NAPSI). The objective of this study is to validate TB-PET/CT imaging as a diagnostic tool and for describing systemic disease activity of PsA.

Methods: We have prospectively recruited 40 participants (30 male, 10 female), with PsA (n=15), RA (n=10), and OA (n=15). All subjects underwent a single-timepoint TB-PET/CT scan on the uEXPLORER scanner using the PET radiotracer 18F-FDG. Qualitative findings and different patterns for these 3 conditions were evaluated. We quantified the degree of inflammation (SUVmax) and determined pathologic predilection for anatomical domains of bones/ligaments of in PsA, RA and OA.

Results: In PsA patients, large number of joints showed positive findings in all participants. Multiple sites of enthesitis were visualized in the majority of scans (n=14/15). Furthermore, nail matrix showed increased uptake in 9/15 participants. Less frequent features included spine involvement of the supra/interspinous ligaments/bursae (n=6), sacroiliac joint (n=2), and dactylitis (n=2).

The uptake patterns and intensity were significantly different in patients with PsA compared to those with OA and RA (Fig 1 A and 1B). Fig 1 A, shows in PsA, joints were affected asymmetrically. In the Fig 1 B PET-CT imaging of the hands in PsA compared to RA clearly had: (a) asymmetry (b) also other characteristic pathologies such as in PsA there is inflammation of the extensor tendon and DIP in the left index along with marked nail matrix inflammation. The relative maximum standardized uptake value (rSUVmax) was significantly higher in participants with PsA compared to OA. There was a fair (68%) agreement between the DAPSA score and the PET averaged SUVmax. Figure 2 demonstrates the significance of a single TB-PET/CT scan in identifying the extent and the nature of joint, entheses, and nail involvement in PsA.

Conclusion: Our results indicates that TB-PET/CT measures can identify unique pathologies of PsA (Fig 1 and Fig 2) compared to RA and OA such as (i) asymmetric synovitis of large and small joints, (ii) systemic generalized enthesitis (iii) DIP inflammation, (iv) inflammation of the extensor tendons of fingers and its association with its enthesitis and adjacent nail matrix inflammation, (v) nail matrix inflammation, (vi) dactylitis, (vii) spondyloarthritis with sacroiliitis and diffuse enthesitis of the spine.

These observations substantiate our proposal that TB-PET/CT identifies the pathologies unique for 5 clinical domains of PsA, differentiates from RA/PsA, provides a diagnosis, extent/severity of the disease with a quantitative measure of total inflammatory burden and identifies subclinical developing pathologies of PsA. Thus, a diagnostic tool for early disease at the point of transition from psoriasis.

Figure 1: A. TB-PET/CT scans: Left: In PsA, showing multiple joints affected asymmetrically. Center: In RA: multiple joints affected, symmetric; including the shoulders, PIP joints of the hands and knees. Right: In OA, with few affected joints left elbow, right knee and right big toe. Figure 1: B. Compared to RA in PsA: (i) arthritis of small joints is asymmetric; evidenced by sparing of PIP/DIP of 3rd,4th,5th digits in the left hand (ii) there is inflammation of the extensor tendon and DIP in the left index finger and marked nail matrix inflammation in several fingers in both hands.

Figure 2. A single Total Body-PET/CT scan can identify the extent and the nature of joint, spine, entheses, and nail involvement in PsA.


Disclosures: S. Raychaudhuri, Johnson & Johnson, 1, Abbvie, 5, 6, Sun Pharma, 5, UCB company, 1, Novartis, 1, Pfizer, 5; Y. Abdelhafez, None; S. Kundu-Raychaudhuri, Sun Pharma, 5; A. Chaudhari, None.

To cite this abstract in AMA style:

Raychaudhuri S, Abdelhafez Y, Kundu-Raychaudhuri S, Chaudhari A. Total-Body 18F-FDG PET/CT Imaging: A Tool for Diagnosis and Quantifying Inflammatory Burden of Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/total-body-18f-fdg-pet-ct-imaging-a-tool-for-diagnosis-and-quantifying-inflammatory-burden-of-psoriatic-arthritis/. Accessed May 30, 2023.
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