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Monitoring rheumatoid arthritis synovitis with ^99mTc-anti-CD3

¹ Departamento de Radiologia and ² Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, ³ Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Juiz de Fora, Brazil

Correspondence: Prof. B Gutfilen, PhD, Univ Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Dep de Radiologia, sub-solo, Av Brigadeiro Trompovsky s/no, Ilha do Fundão, CEP 21941590 Rio de Janeiro, Brasil. E-mail: bgutfilen{at}hucff.ufrj.br

The aim of this study was to investigate the feasibility of using a monoclonal antibody (OKT3) labelled with technetium-99m (^99mTc) to monitor disease activity in patients with rheumatoid arthritis. We evaluated 38 patients who were diagnosed with rheumatoid arthritis and classified as Classes II and III after functional assessment (according to the revised criteria specified by the American College of Rheumatology). Two sets of planar anterior images of the patients' wrists, metacarpophalangeal and interphalangeal joints, elbows, shoulders and knees joints were obtained 1 h and 3 h after the injection of ^99mTc–OKT3. The scintigraphic findings showed significant correlation (p<0.05) between the radiopharmaceutical accumulation of ^99mTc–OKT3 and swollen joints, tender joints and the visual analogue scale. They were able to differentiate patients in remission from patients with active synovitis, according to DAS 28. In contrast, there was no correlation between the radiopharmaceutical accumulation and the patients' age, gender, duration of disease or erythrocyte sedimentation rate. A relatively high disease activity score of 28 joints (4.08±1.74) was found in the majority of patients. In conclusion, ^99mTc–OKT3 scintigraphy is a reliable and objective method for detecting synovial activity, and can be used to observe disease prognosis.