Thermal Imaging in Assessment of Drugs in Rheumatology

  • P. A. Bacon
  • E. F. J. Ring


In a disease with no known cure, drug treatment has to be rigorously assessed, but assessment in rheumatic diseases is not a simple process. This is attested to by the extensive literature on the subject and the large number of tests available (for review, see 1). It is clear that no one single test adequately reflects the complex changes which occur in the whole patient with an inflammatory arthritis. For this reason, most drug trials include a battery of tests which measure joint pain, joint tenderness and joint function. In addition, the patient’s preference and various laboratory tests are subjective and will be strongly influenced by the patient’s state of mind and his relationship with the drug trialist. The problems of placebo response in chronic diseases, such as rheumatoid arthritis, are well known. There is, therefore, strong need for an objective test which would indicate the changes in joint inflammation, independently of pain or pain threshold. Ideally such a test needs to be simple, cheap, non-invasive, repeatable and easily reproducible and acceptable to the patient. The only two methods which fulfil even some of these ideals are the use of radioisotope scanning of joints and infrared thermography. Both of these reflect chiefly the increased vascularity of inflammation and are not influenced by pain. Isotopes suffer from the disadvantages of any radioactive material and are invasive. Thus, thermography seems to be a logical choice. Extensive work in Bath over the last decade has suggested that thermography does indeed have many advantages and correlates with a number of aspects of joint pathology. These have included intra-articular temperature, vascularity of the joint as measured by both plethysmography and isotope studies, inflammatory changes in the synovial fluid as reflected by the white count, the total volume, and the protein content, and the synovial pathology as assessed microscopically at operation and histochemically using intracellular cathepsin levels. These correlations have previously been extensively reviewed.2


Rheumatoid Arthritis Rheumatic Disease Grip Strength Joint Tenderness Gouty Arthritis 
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Copyright information

© Plenum Press, New York 1984

Authors and Affiliations

  • P. A. Bacon
    • 1
  • E. F. J. Ring
    • 1
  1. 1.Department of RheumatologyUniversity of Birmingham and Royal National Hospital for Rheumatic DiseasesBathUK

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