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Evaluation of synovial angiogenesis in patients with rheumatoid arthritis using 68Ga-PRGD2 PET/CT: a prospective proof-of-concept cohort study
  1. Zhaohui Zhu1,
  2. Yufeng Yin2,
  3. Kun Zheng1,
  4. Fang Li1,
  5. Xiaoyuan Chen3,
  6. Fengchun Zhang2,
  7. Xuan Zhang2
  1. 1Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  3. 3Laboratory of Molecular Imaging and Nano-Medicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, USA
  1. Correspondence to Xuan Zhang, Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China; zxpumch2003{at}sina.com; and Zhaohui Zhu, MD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China; zhuzhh{at}pumch.cn

Abstract

Background The study aimed to evaluate the use of positron emission tomography/computed tomography (PET/CT) with 68Ga-PRGD2 as the tracer for imaging of synovial angiogenesis in patients with rheumatoid arthritis (RA).

Methods Twenty untreated active patients with RA underwent 68Ga-PRGD2 PET/CT and 18F-FDG PET/CT before treatment; two patients with osteoarthritis served as controls. Among the 20 patients with RA, 12 repeated the evaluations after 3-month treatment. The image findings were correlated with core variables of disease activity, including the clinical disease activity index (cDAI).

Results Our findings demonstrated that 68Ga-PRGD2 specifically accumulated in the synovia with active inflammation rich in neovasculature with high-level αvβ3-integrin expression, but not in the 18F-FDG-avid inflammatory lymph nodes. In patients with intense 18F-FDG uptake in muscles caused by arthritic pain, we observed that 68Ga-PRGD2 PET/CT was better able to evaluate disease severity than 18F-FDG PET/CT. Both 68Ga-PRGD2 accumulation and 18F-FDG uptake changed in response to therapeutic intervention, whereas the changes of 68Ga-PRGD2, not 18F-FDG, significantly correlated with clinical measures of changes in the form of cDAI.

Conclusions This is the first integrin imaging study conducted in patients with RA that preliminarily indicates the effectiveness of the novel method for evaluating synovial angiogenesis.

Clinical trial registration This study has been registered online at NIH ClinicalTrial.gov (NCT01940926).

  • Rheumatoid Arthritis
  • Arthritis
  • Disease Activity

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