Macrophage positron emission tomography imaging as a biomarker for preclinical rheumatoid arthritis: Findings of a prospective pilot study
Macrophage positron emission tomography imaging as a biomarker for preclinical rheumatoid arthritis: Findings of a prospective pilot study
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DOI：
10.1002/art.30655
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发表时间：
2012-01-01
影响因子：
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通讯作者：
van der Laken, Conny J.
中科院分区：
文献类型：
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作者：
Gent, Yoony Y. J.;Voskuyl, Alexandre E.;van der Laken, Conny J.
目的探讨11C-(R)-PK11195正电子发射断层扫描(PET)靶向巨噬细胞能否显示抗核苷蛋白抗体(ACPAs)阳性关节痛患者的亚临床滑膜炎。对29例ACPAs阳性但无临床关节炎的关节痛患者进行了研究。对手部和手腕进行高(空间)分辨率(11)C-(R)-PK11195 PET扫描。对于所有掌指关节、近端指间关节和腕关节(即每个患者22个关节)，示踪剂摄取由2名观察者进行半定量评分(0-3分)，他们的临床数据是盲目的。对患者进行24个月的前瞻性随访，了解临床关节炎的发展情况。两名观察者读数的总体一致性和kappa值在患者水平分别为97%和0.91(95%可信区间[95%CI]0.74-1)，在联合水平分别为99%和0.81(95%可信区间0.65-0.96)。在4名患者中，基线时发现至少1个和多达5个PET阳性关节(评分=1)。随访2年内，9例患者出现临床关节炎。这包括所有4名在(11)C-(R)-PK11195扫描中呈阳性结果的患者，他们在PET扫描中发现手/手腕区域出现了临床关节炎。在其余5例PET扫描结果为阴性的关节炎患者中，2例发生在手关节，3例发生在PET扫描视野之外的位置。ACPA阳性关节痛患者的亚临床关节炎可通过(11)C(R)-PK11195 PET扫描显示，并与2年内关节炎的发生有关。这表明，(11)C-(R)-PK11195 PET可用于确定RA临床前期的关节炎活动度。
Objective To conduct a prospective pilot study to determine whether macrophage targeting by 11C-(R)-PK11195 positron emission tomography (PET) can visualize subclinical synovitis in arthralgia patients who have anticitrullinated protein antibodies (ACPAs).Methods. Twenty-nine arthralgia patients who were positive for ACPAs but did not have clinical arthritis were studied. High (spatial)-resolution (11)C-(R)-PK11195 PET scans of the hands and wrists were performed. For all metacarpophalangeal, proximal interphalangeal, and wrist joints (i.e., 22 joints per patient), tracer uptake was scored semiquantitatively (0-3 scale) by 2 observers who were blinded with regard to the clinical data. Patients were followed up prospectively for 24 months to investigate the development of clinical arthritis.Results. Overall agreement and kappa values for the readings of the 2 observers were, respectively, 97% and 0.91 (95% confidence interval [95% CI] 0.74-1) at the patient level and 99% and 0.81 (95% CI 0.65-0.96) at the joint level. In 4 patients, at least 1 and as many as 5 PET-positive joints (score >= 1) were found at baseline. Within 2 years of followup, 9 patients had developed clinical arthritis. This included all 4 patients with positive findings on the (11)C-(R)-PK11195 scan, who developed clinical arthritis in the hand/wrist region, as identified on PET scans. Of the 5 remaining arthritis patients with negative findings on PET scans, 2 developed arthritis in the hand joints and 3 developed arthritis at locations outside the field of view of the PET scanner.Conclusion. Subclinical arthritis in ACPA-positive arthralgia patients could be visualized by (11)C(R)-PK11195 PET scanning and was associated with development of arthritis within 2 years of followup. This indicates that (11)C-(R)-PK11195 PET may be useful in determining arthritis activity in the preclinical phase of RA.