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Imaging neoangiogenesis in rheumatoid arthritis (INIRA): whole-body synovial uptake of a 99mTc-labelled RGD peptide is highly correlated with power Doppler ultrasound
  1. Laura Attipoe1,2,
  2. Khaldoun Chaabo2,
  3. Julekha Wajed2,
  4. Fahim-Ul Hassan3,
  5. Dharsene Shivapatham2,
  6. Matthew Morrison4,
  7. Jim Ballinger5,
  8. Gary Cook6,
  9. Andrew P Cope1,2,
  10. Toby Garrood2
  1. 1 Academic Department of Rheumatology, King's College London, London, UK
  2. 2 Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3 Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
  4. 4 GE Healthcare Diagnostic Imaging, Little Chalfont, Buckinghamshire, UK
  5. 5 Nuclear Medicine, King's College London, London, UK
  6. 6 Cancer Imaging, King's College London, London, UK
  1. Correspondence to Dr Laura Attipoe, Academic Department of Rheumatology, King's College London, London WC2R 2LS, UK; lattipoe{at}

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Ultrasound (US) is superior to clinical examination in detecting synovitis in patients with rheumatoid arthritis (RA).1 It is dynamic, relatively cheap and can be used in the clinic. However, it is time consuming and impractical to image large numbers of joints. There is no consensus on the minimum US joint count required to adequately reflect the burden of disease activity. MRI has similar sensitivity to US for detecting synovitis but again is time consuming, expensive and may not be tolerated by some patients. Both modalities require expertise to interpret the images. Three-phase bone scintigraphy has good sensitivity, but due to lower specificity, it is not routinely used to detect synovitis.2

Integrin αvβ3 is a cell adhesion molecule upregulated on activated vascular endothelial cells in neoangiogenesis. It is overexpressed in the inflamed synovium and on activated cells such as osteoclasts.3 99mTc-maraciclatide (Serac Healthcare) is a radiolabelled tracer containing the RGD tripeptide motif which binds with high affinity to αv …

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  • Handling editor Josef S Smolen

  • Contributors The lead author wrote the letter with guidance from Dr Toby Garrood and Professor Andrew Cope. Matthew Morrison on behalf of GE Healthcare provided the tracer used for the study. The tracer is now owned by SERAC Healthcare. All other authors were involved in the study by way of recruiting patients and/or analysing data. Coauthors have approved the letter submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MM is an employee of GE Healthcare who at the time of the study were the owners of the 99mTc-maraciclatide tracer. The tracer is now owned by SERAC Healthcare. GC is offered non-financial support from GE Healthcare. Guy's and St Thomas' NHS Foundation Trust has a United States use patent for 99mTc-maraciclatide issued on 26th March 2020. TG became a shareholder in Serac Healthcare on 8th April 2020.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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