Abstract
Purpose
This study evaluated the potential of functional imaging to monitor disease activity and response to treatment with disease-modifying antirheumatic drugs (DMARD) in DMARD-naive patients with early rheumatoid arthritis (RA).
Methods
The study involved 17 patients with active RA in whom combination therapy was initiated with methotrexate, sulfasalazine, hydroxychloroquine, and low-dose oral prednisolone. Clinical disease activity was assessed at screening, at baseline and after 2, 4, 8 and 12 weeks of therapy. 18F-FDG PET/CT of all joints was performed at baseline and after 2 and 4 weeks of therapy.
Results
18F-FDG maximum standardized uptake values showed a reduction of 22 ± 13 % in 76 % of patients from baseline to week 2 and a reduction of 29 ± 13 % in 81 % of patients from baseline to week 4. The percentage decrease in 18F-FDG uptake from baseline to week 2 correlated with clinical outcome, as measured by the disease activity score (DAS-28) at week 12. In addition, changes in C-reactive protein levels and erythrocyte sedimentation rate were positively associated with changes shown by PET.
Conclusion
18F-FDG PET/CT findings after 2 and 4 weeks of triple combination oral DMARD therapy correlated with treatment efficacy and clinical outcome in patients with early RA. 18F-FDG PET/CT may help predict the therapeutic response to novel drug treatments.
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Acknowledgments
We thank Drs. Laura Pirilä, Maija Puurtinen-Vilkki and Aki Similä for their help in recruiting patients for this study. We acknowledge the help of Hannu Sipilä in designing tailored hand and ankle immobilization systems for use during PET/CT. We thank Dr. Jukka Kemppainen and Mrs. Mia Koutu for helping with PET/CT imaging, Mrs. Irina Lisinen and Mr. Ville Aalto for statistical analysis and Dr. Stanford Peng for his help with the study design.
Conflicts of interest
A.R., S.H., T.M., P.N., V.O., R.P., M.S. and T.Y.-K. declare no conflicts of interest. L.P., R.R. and N.S. are employees of Hoffmann-La Roche.
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Roivainen, A., Hautaniemi, S., Möttönen, T. et al. Correlation of 18F-FDG PET/CT assessments with disease activity and markers of inflammation in patients with early rheumatoid arthritis following the initiation of combination therapy with triple oral antirheumatic drugs. Eur J Nucl Med Mol Imaging 40, 403–410 (2013). https://doi.org/10.1007/s00259-012-2282-x
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DOI: https://doi.org/10.1007/s00259-012-2282-x