USE OF THERMAL AND 3D IMAGING TO QUANTIFY ARTHRITIS

描述（由申请人提供）：在护理类风湿关节炎（RA）和幼年类风湿关节炎（JRA）患者时，最大的挑战之一是量化任何给定关节的疾病活动程度。甚至很难确定是否存在炎症。我们已经建立了一个原型装置，使用完善的传感器，特别是三维激光线三角测量数字化摄像机和热红外摄像机，来快速量化关节炎关节的表面肿胀和热量。这种关节炎表面成像仪在几分钟内产生结果。因此，它可以成为风湿病门诊就诊的常规组成部分，允许用定量和高度可重复的测量方法取代目前主观和不可靠的联合评估，可用于长期监测患者。我们研究的目的是验证这种成像仪可以改善关节炎临床评估的假设。第一个特定目的是验证一个假设，即表面成像将比医生评估和患者自我评估更早、更敏感地衡量活动性关节炎和功能状态的变化。一组JRA和RA患者将在治疗干预前和治疗干预过程中进行纵向随访。关节炎表面成像仪测量的关节炎变化将与完善和有效的临床测量进行比较，包括1)医生对关节压痛和肿胀的评估和2)患者对关节疼痛的自我评估。与手功能有关的儿童健康评估问卷（CHAQ）和健康评估问卷（HAQ）的组成部分也将与功能状态的变化产生相关性。我们还将研究功能状态变化的预测因子。第二个特定目标将测试假设，表面成像可以提高缓解测量的准确性。最近有报道称，临床缓解的患者通常有持续滑膜炎的MRI证据，这表明目前临床测量的不活动与真正的缓解并不相关。我们的初步研究表明，许多有关节炎史的患者即使在无症状的情况下也有异常的关节热模式。临床不活跃疾病的患者将通过MRI成像，以确定是否可以通过关节炎表面成像仪识别亚临床关节炎患者。低成本、省时的工具可以产生一套可靠、可重复和客观的关节炎症状态测量方法，这将改善关节炎临床研究结果的评估，并最终改善患者护理。该建议的重点是手腕和掌指关节（MCP），它们占疾病活动评分（DAS） 28个关节中的22个。这里开发的方法可以很容易地应用于其他周围关节。医师评估肿胀和/或压痛关节数量的可重复性。

DESCRIPTION (provided by applicant): One of the biggest challenges in caring for patients with Rheumatoid Arthritis (RA) and Juvenile Rheumatoid Arthritis (JRA) is quantifying the degree of disease activity in any given joint. It can even be difficult to determine whether inflammation is present or absent. Carefully designed studies have repeatedly shown poor We have built a prototype device using well-established sensors-specifically 3-dimensional (3D) laser line triangulation digitizer cameras and thermal infrared cameras-to rapidly quantify surface swelling and heat in arthritic joints. This Arthritis Surface Imager produces results within minutes. Thus it could become a routine component of the rheumatology clinic visit, allowing for the replacement of the current subjective and unreliable joint assessment with a quantitative and highly-reproducible measure that can be used to monitor patients over time. The goal of our studies is to test the hypothesis that this Imager can improve the clinical assessment of arthritis. The first Specific Aim is to test the hypothesis that surface imaging will provide an earlier and more sensitive measure of change in active arthritis and functional status than do physician's assessment and patient's self-assessment A cohort of patients with JRA and RA will be followed longitudinally before and during the course of a therapeutic intervention. Change in arthritis, as measured by the Arthritis Surface Imager will be compared to well-established and validated clinical measures, including 1) physician's assessment of joint tenderness and swelling and 2) patient's self-assessment of joint pain. Correlation will also be made with changes in functional status, as assessed by components of the Childhood Health Assessment Questionnaire (CHAQ) and Health Assessment Questionnaire (HAQ) that pertain to hand function. We will also examine predictors of change in functional status. The second Specific Aim will test the hypothesis that surface imaging can improve the accuracy of remission measurement. It has recently been reported that patients in clinical remission often have MRI evidence of continued synovitis, demonstrating that current clinical measures of inactivity do not correlate well with true remission. Our Preliminary Studies suggest that many patients with a history of arthritis have abnormal joint thermal patterns even when asymptomatic. Patients with clinically-inactive disease will be imaged by MRI to determine whether patients with subclinical arthritis can be identified by the Arthritis Surface Imager. Low-cost, time-efficient tools that produce a set of reliable, reproducible and objective measures of the inflammatory state of the joint would improve the assessment of outcome in arthritis clinical studies, and ultimately will improve patient care. This proposal focuses on the wrist and metacarpophalangeal (MCP) joints, which make up 22 of the 28 joints in the Disease Activity Score (DAS) 28. Methodologies developed here could be readily applied to other peripheral joints. reproducibility of physician assessment of the number of swollen and/or tender joints. PUBLIC HEALTH RELEVANCE: One of the biggest challenges in caring for patients with Rheumatoid Arthritis (RA) and Juvenile Rheumatoid Arthritis (JRA) is quantifying the degree of disease activity in any given joint. We have built a prototype device using well-established sensors to rapidly quantify surface swelling and heat in arthritic joints. The goal of our studies is to test the hypothesis that this Imager can improve the clinical assessment of arthritis.