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World J Orthop. Jul 18, 2014; 5(3): 312-318
Published online Jul 18, 2014. doi: 10.5312/wjo.v5.i3.312
Rheumatoid arthritis: Nuclear Medicine state-of-the-art imaging
Paulo Henrique Rosado-de-Castro, Sergio Augusto Lopes de Souza, Dângelo Alexandre, Lea Mirian Barbosa da Fonseca, Bianca Gutfilen
Paulo Henrique Rosado-de-Castro, Sergio Augusto Lopes de Souza, Lea Mirian Barbosa da Fonseca, Bianca Gutfilen, Departamento de Radiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
Dângelo Alexandre, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro 20940-070, Brazil
Author contributions: Rosado-de-Castro PH, Lopes de Souza SA, Alexandre D, Barbosa da Fonseca LM and Gutfilen B performed the literature review, drafted the article, revised the article critically for important intellectual content and finally approved for print.
Correspondence to: Bianca Gutfilen, PhD, Professor, Departamento de Radiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro 21941-913, Brazil.
Telephone: +55-21-25622399 Fax: +55-21-25622399
Received: December 27, 2013
Revised: April 4, 2014
Accepted: April 25, 2014
Published online: July 18, 2014

Rheumatoid arthritis (RA) is an autoimmune disease, which is associated with systemic and chronic inflammation of the joints, resulting in synovitis and pannus formation. For several decades, the assessment of RA has been limited to conventional radiography, assisting in the diagnosis and monitoring of disease. Nevertheless, conventional radiography has poor sensitivity in the detection of the inflammatory process that happens in the initial stages of RA. In the past years, new drugs that significantly decrease the progression of RA have allowed a more efficient treatment. Nuclear Medicine provides functional assessment of physiological processes and therefore has significant potential for timely diagnosis and adequate follow-up of RA. Several single photon emission computed tomography (SPECT) and positron emission tomography (PET) radiopharmaceuticals have been developed and applied in this field. The use of hybrid imaging, which permits computed tomography (CT) and nuclear medicine data to be acquired and fused, has increased even more the diagnostic accuracy of Nuclear Medicine by providing anatomical localization in SPECT/CT and PET/CT studies. More recently, fusion of PET with magnetic resonance imaging (PET/MRI) was introduced in some centers and demonstrated great potential. In this article, we will review studies that have been published using Nuclear Medicine for RA and examine key topics in the area.

Keywords: Rheumatoid arthritis, Nuclear medicine, Scintigraphy, Single photon emission computed tomography, Positron emission tomography

Core tip: In recent years, the use of nuclear medicine to characterize and diagnose infectious and inflammatory diseases has been rapidly increasing. In the case of rheumatoid arthritis (RA), the success of treatment requires improvement of early diagnosis and assessment of response to anti-inflammatory therapy. In this setting, Nuclear Medicine may be valuable in the assessment of early inflammatory activity in RA, foreseeing and monitoring response to treatment, and allowing the selection of optimal treatments for each patient. The development of new radiopharmaceuticals and hybrid imaging technologies may improve the potential of molecular imaging in the field.