Evaluating disease activity in patients with ankylosing spondylitis and rheumatoid arthritis using 99mtc-glucosamine

Abstract

Objective: To evaluate the clinical utility of a novel radiotracer, Tc-glucosamine, in assessing disease activity of both rheumatoid arthritis (RA) and ankylosing spondylitis (AS).Material and Methods: Twenty-five patients with RA (nine males and 16 females) and 12 patients with AS (all male) at various stages of disease were recruited for the study. A clinical history and examination was performed, followed by the measurement of hematological, biochemical, and autoimmune serological parameters to assess disease activity. Tc-glucosamine was intravenously administered and scans were compared with other imaging modalities, including plain X-ray, magnetic resonance imaging (MRI), and bone scans. Results: In patients with AS, 99mTc-glucosamine scans were more capable of identifying active disease and differentiating between inflammatory and non-inflammatory causes. In patients with RA, 99m Tc-glucosamine accumulated at all known sites of disease involvement. Uptake was most pronounced in patients with active untreated disease. The relative tracer activity in the involved joints increased with time compared with that in the adjoining soft tissue, liver, and cardiac blood pool. Using Spearman's correlation coefficient, there was a positive correlation among glucosamine scan scores, C-reactive protein (p=0.048), and clinical assessment (p=0.003), which was not noted with bone scans. Conclusion:The radiotracer was well tolerated by all patients, with no adverse reactions. Tc-labeled methylene diphosphonate nuclear bone scans for imaging inflamed joints and had the added advantage of demonstrating a significant clinical correlation between disease activity and scan findings.Keywords: Glucosamine, rheumatoid arthritis, ankylosing spondylitis, nuclear scan ments of cells at these sites. Tc-glucosamine can be locally produced by a nuclear scientist in a major nuclear medicine department and administered to a patient, as one would for a bone scan, and it is easy to produce, cheap to administer, and accessible. Other similar analogs of glucosamine, such as N-[2,4,5-trihydroxy-6-(hydroxymethyl) tetrahydro-2H-pyran-3-yl] acrylamide, have been demonstrated to have anti-arthritic and immunomodulatory effects in adjuvant-induced arthritis but are yet to be tested in humans as imaging agents (9).In this study, we extended our prior pilot investigations and evaluated 99m Tc-glucosamine imaging modality for its clinical utility, limitations, and applications, particularly in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Tc-glucosamine joint uptake was correlated with MRI, bone scans, and in three cases, the effect of anti-tumor necrosis factor (anti-TNF) treatment on scanning before and after therapy. Material and MethodsEthics approval All patients provided their written informed consent. The Western Sydney Local Health District Human Research Ethics Committee granted ethics approval for this study. Study populationPatients fulfilling the American College of Rheumatology revised criteria for...

The Biodistribution and Utility of 99mTc-Ethylenedicysteine-Deoxyglucose (99mTc-Glucosamine) in the Identification of Active Disease in Patients with Rheumatoid Arthritis—a Single Center Prospective Study

“…The findings indicated that most of our participants had increased uptake of 99m Tc-ECDG in their clinically affected joints, with varying degrees of uptake. This is not different from the few studies that have used 99m Tc-ECDG to evaluate disease activity in patients with RA [ 6 , 14 ]. However, the level of agreement with the two modalities (clinical evaluation and 99m Tc-ECDG), expressed as percentages in the detection of synovitis in the knees, wrists, and hands, was 85, 75, and 56.2%, respectively.…”

“…However, these imaging modalities are not without their drawbacks. The major drawback of US is that it is operator-dependent and cumbersome, especially when almost every joint in both hands must be evaluated [ 4 , 6 ]. The inconvenience of this method is further increased if additional joints beside those in the hands need evaluation.…”

“…Glucosamine is an important basic natural component of cartilage and synovial fluid [ 15 ], and radiolabeled glucosamine may therefore find useful application for joint imaging and evaluation of patients with RA. Very few studies have shown the potential utility of 99m Tc-ECDG imaging in patients with RA [ 6 , 14 ]. The aim of this study was therefore to, in a prospective manner, investigate 99m Tc-ECDG, within a local context, for the evaluation of active joint disease in patients with RA, including evaluation of the general whole body biodistribution of the radiopharmaceutical.…”

The prognostic value of 99mTc-glucosamine imaging in patients with rheumatoid arthritis: a single center prospective study

“…Technetium-99 metastable ( 99m Tc) labeled glucosamine is a radiolabelled glucose analog that has been used for imaging active joint disease in patients with RA [7,8]. It offers an alternative to fluorine-18-fluorodeoxyglucose PET computed tomography ( 18 F-FDG PET/CT) imaging of patients with RA in facilities that do not have PET/CT machines.…”

Correspondence on ‘Glucosamine and O-GlcNAcylation: a novel immunometabolic therapeutic target for OA and chronic, low-grade systemic inflammation?’

“…4 We have radiolabelled GlcN with 99m-Technetium ( 99m Tc) and administered it intravenously to patients with varied rheumatic conditions including rheumatoid arthritis, ankylosing spondylitis and OA. 5 GlcN consumption was ceased 3-5 days prior to administration of this agent, to reduce any competitive inhibition of uptake.…”