18F-sodium fluoride PET-CT visualizes both axial and peripheral new bone formation in psoriatic arthritis patients

Jerney de Jongh; Robert Hemke; Gerben J C Zwezerijnen; Maqsood Yaqub; Irene E van der Horst-Bruinsma; Marleen G H van de Sande; Arno W R van Kuijk; Alexandre E Voskuyl; Conny J van der Laken

doi:10.1007/s00259-022-06035-w

¹⁸F-sodium fluoride PET-CT visualizes both axial and peripheral new bone formation in psoriatic arthritis patients

Eur J Nucl Med Mol Imaging. 2023 Feb;50(3):756-764. doi: 10.1007/s00259-022-06035-w. Epub 2022 Nov 12.

Authors

Jerney de Jongh¹, Robert Hemke², Gerben J C Zwezerijnen³, Maqsood Yaqub³, Irene E van der Horst-Bruinsma⁴, Marleen G H van de Sande⁵, Arno W R van Kuijk⁶, Alexandre E Voskuyl⁷, Conny J van der Laken⁷

Affiliations

¹ Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Location VUmc, P.O. Box 7057, Amsterdam, the Netherlands. j.dejongh2@amsterdamumc.nl.
² Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location AMC, 1007 MB, Amsterdam, The Netherlands.
³ Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
⁴ Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵ Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
⁶ Department of Rheumatology, Reade, Amsterdam, the Netherlands.
⁷ Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Location VUmc, P.O. Box 7057, Amsterdam, the Netherlands.

Abstract

Purpose: As bone formation is associated with psoriatic arthritis (PsA), positron emission tomography (PET) using a ¹⁸F-Fluoride tracer may enable sensitive detection of disease activity. Our primary aim was to determine the feasibility of whole-body ¹⁸F-sodium fluoride PET-CT in clinically active PsA patients to depict new bone formation (as a reflection of disease activity) at peripheral joints and entheses. Our secondary aim was to describe ¹⁸F-sodium fluoride findings in the axial skeleton.

Methods: Sixteen patients (female 10/16, age 50.6 ± 8.9 years) with PsA fulfilling CASPAR criteria or with a clinical diagnosis of PsA according to the treating rheumatologist and with ≥ 1 clinically active enthesitis site were included. Of each patient, a whole-body ¹⁸F-sodium fluoride PET-CT scan was performed. All scans were scored for PET-positive lesions at peripheral joints, enthesis sites and the spine. Clinical disease activity was assessed by swollen/tender joint count 44, enthesitis according to MASES and SPARCC scores.

Results: Out of 1088 evaluated joints, 109 joints showed PET enhancement, mainly in the interphalangeal and metatarsal joints of the feet (14/109, 12.9%) and the distal interphalangeal joints of the hands (14/109, 12.9%). PET positivity was found at 44/464 enthesis sites, mainly at the patella tendon insertion (11/44, 25%) and quadriceps tendon insertion (10/44, 22.7%). Of the PET-positive joints and enthesis sites, respectively 18.2% and 29.5% were clinically positive; 81.8% and 70.5% of the PET-positive joints and entheses respectively were clinically asymptomatic. In 11 patients, ≥ 1 axial PET-positive lesion was observed, mainly in the cervical spine.

Conclusions: New molecular bone formation was observed on ¹⁸F-sodium fluoride PET-CT scans, in all domains in which PsA disease activity can be observed, with a substantial part showing no clinical symptoms.

Clinical trial registration: EudraCT: 2017-004,850-40, registered on 13 December 2017.

Keywords: 18F-sodium fluoride PET/CT; Bone formation; Feasibility; Psoriatic arthritis.

MeSH terms

Adult
Arthritis, Psoriatic* / diagnostic imaging
Female
Humans
Middle Aged
Osteogenesis
Positron Emission Tomography Computed Tomography / methods
Positron-Emission Tomography / methods
Sodium Fluoride

Substances

Sodium Fluoride