A pinboard by
Yogan Kisten

PhD student, Karolinska Institute


Using advanced imaging tools to early detect rheumatoid arthritis & monitor the effects of therapy

An important unmet medical need is the availability of safe & affordable medical tools that will allow the doctor to better stratify arthritis patients, in order to identify who are at risk of developing Rheumatoid Arthritis (RA), and who may already have the disease sub-clinically, that are suitable for aggressive early therapies. In this context, several imaging techniques, specifically ultrasound and MRI investigations of the joints, have proven useful in both early diagnosis and prediction. In a recent report, we showed ultrasound to have significantly increased the rheumatologist's confidence & diagnostic certainty in establishing the presence and absence of joint inflammation.

We also showed the potential benefits of fluorescence optical imaging (FOI) in various rheumatic diseases. FOI is a novel operator-independent and time efficient imaging modality (that can also be performed by nurses or other non-MD personnel), and is showing great potential in early detection and quantification of joint inflammation. It utilizes an intravenous contrast medium that allows the visualization of altered micro-circulation in the hands & wrists. It has the ability to detect sub-clinical inflammation in real-time, and is seen as focal optical signal intensities in areas of high perfusion, and/or capillary leakage. FOI correlates positively with ultrasound and MRI findings in evaluating disease activity and synovitis (inflammation). Realizing FOI's potential of very early detecting inflammation, with an ability to objectively monitor the effects of therapy, we now determine the utility of this modality in the context of individuals at risk for developing RA.

The overall aim of the current project is to investigate the usefulness of ultrasound and fluorescence optical imaging as diagnostic and predictive tools in patients with very early RA, as well as in individuals at risk for developing the disease, so that preventative and interventional measures can be very early adopted as part of strategic patient management .

We have been the 1st in Scandinavia to implement Fluorescence Optical Imaging (FOI) as part of patient care, when clinically justified by a referring physician at our early arthritis clinic of the Karolinska University Hospital, in Sweden.

Our research findings are also revealing FOI's potential to distinguish between RA prototypes of seropositive versus seronegative rheumatoid arthritis, which we will share at the following conference presentations