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  • Review Article
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Emerging optical and nuclear medicine imaging methods in rheumatoid arthritis

Nature Reviews Rheumatology volume 8, pages 719–728 (2012)Cite this article

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Abstract

Molecular and multimodal imaging procedures that complement the use of existing anatomical modalities for the diagnosis and monitoring of rheumatoid arthritis (RA) have undergone substantial developmental advances. These techniques have the potential to greatly improve the management of patients with RA through early diagnosis and maximization of the newly available opportunities for early therapeutic intervention. Quantitative, noninvasive monitoring of biomarkers of the molecular events induced during the onset of RA could be used to guide the initial selection of therapy and for assessment of early therapeutic responses. Biomolecular imaging techniques that can reveal the pathophysiological features of RA—including infrared thermography, near-infrared molecular imaging, and PET—are being used to investigate the earliest cellular and biochemical inflammatory events in the development of the disease. Noninvasive imaging of abnormal specific molecular events in early RA could enable early targeted intervention that could be tailored to optimize patient responses before destructive anatomical changes occur. In this Review, we summarize new advances in biomolecular imaging techniques, with an emphasis on their current state of development in terms of the management of RA.

Key Points

  • Biomolecular imaging can detect specific molecular events that are associated with the onset and progression of RA

  • Thermography can be used to detect and quantitatively assess clinically meaningful changes in arthritic joints

  • Near-infrared imaging can detect a broad spectrum of specific enzymatic activities, including local levels of caspase or cathepsin activity

  • PET imaging is a highly specific and sensitive technique that can be used to assess biochemical processes, such as cell metabolism, angiogenesis and apoptosis

  • Noninvasive whole-body analysis of specific molecular events during the onset of RA could facilitate early intervention and the use of tailored therapies to optimize the responses of individual patients

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Figure 1: Biomolecular imaging techniques used to aid the early diagnosis of RA in research.
Figure 2: Thermal imaging of the left wrist skin surface in a 9-year-old girl with polyarticular juvenile idiopathic arthritis.
Figure 3: Assessment of RA pathophysiology using light scattering through finger joints.
Figure 4: NIR imaging of macrophages and protease activity in mice with CIA.
Figure 5: 18F-FDG-PET–CT imaging in arthritis.
Figure 6: PET quantitation of metabolic activity in RA joints using ROVER software.
Figure 7: Imaging cell death in a mouse model of RA using radiolabelled annexin V.

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Acknowledgements

J. D. Mountz's research work is funded by grants from the American College of Rheumatology Research and Education Foundation—Within Our Reach: Finding a Cure for Rheumatoid Arthritis campaign, the Alliance for Lupus Research—Target Identification in Lupus program, Veterans Administration Merit Review Grants (1I01BX000600-01), and NIH grants (1AI 071110 and ARRA 3RO1AI71110). The authors thank H. Hsu and J. Li for critical reading of this manuscript, F. Hunter for editorial suggestions and C. Humber and D. M. Frasher for assistance with manuscript preparation.

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  1. Department of Radiology, University of Pittsburgh, PET Facility-B-932, 200 Lothrop Street, Pittsburgh, 15213, PA, USA

    James M. Mountz

  2. Hospital of the University of Pennsylvania, 3400 Spruce Street, 19104, PA, USA

    Abass Alavi

  3. Department of Medicine, University of Alabama at Birmingham, Room 307, Shelby Building, 1825 University Boulevard, Birmingham, 35294, AL, USA

    John D. Mountz

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Mountz, J., Alavi, A. & Mountz, J. Emerging optical and nuclear medicine imaging methods in rheumatoid arthritis. Nat Rev Rheumatol 8, 719–728 (2012). https://doi.org/10.1038/nrrheum.2012.148

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