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Rheumatology 2000; 39: 870-874
© 2000 British Society for Rheumatology

Radiolabelled interleukin-1 receptor antagonist for detection of synovitis in patients with rheumatoid arthritis

P. Barrera, C. J. van der Laken1, O. C. Boerman1, W. J. G. Oyen1, M. T. P. van de Ven, P. L. E. M. van Lent, L. B. A. van de Putte and F. H. M. Corstens1

Departments of Rheumatology and
1 Nuclear Medicine, University Hospital, Nijmegen, The Netherlands

Objectives. To investigate the distribution of radiolabelled interleukin-1 receptor antagonist (IL-1ra) in patients with rheumatoid arthritis (RA) and to assess whether this cytokine is suitable for scintigraphic visualization of synovitis.

Methods. In patients with active RA, scintigraphy was performed after a single i.v. dose of [123I]IL-1ra. Clearance and organ distribution of radiolabelled IL-1ra were studied. To assess whether radiolabelled IL-1ra targets the synovial IL-1 receptors, the scintigraphic images obtained with IL-1ra were compared with those obtained by the use of a non-specific control agent. In addition, autoradiography was performed in mice with antigen-induced arthritis that were injected with either radiolabelled IL-1ra or a size-matched, non-receptor-binding protein.

Results. Radiolabelled IL-1ra allowed clear visualization of inflamed joints. Specificity in the detection of synovitis was high, whereas a number of painful and swollen joints were not visualized by scintigraphy. The procedure was well tolerated and [123I]IL-1ra was rapidly cleared from the circulation (t1/2{alpha} 11 min, t1/2ß 612 min) and excreted mainly in the urine. The definition of synovial contours by IL-1ra scintigraphy was not better than that observed with a non-specific agent. Although radiolabelled IL-1ra retained its affinity for IL-1 receptors, no binding to synovium was observed by autoradiography.

Conclusions. Radiolabelled IL-1ra allows the visualization of synovitis in patients with RA. However, neither the imaging nor the autoradiographic studies indicate that joint accumulation of radiolabelled IL-1ra is due to specific IL-1 receptor targeting. IL-1ra has proved its therapeutic value in RA, but with the dose schedule in this study it does not behave as a specific radiopharmaceutical that is suitable for scintigraphic detection of inflammation.

Correspondence to: P. Barrera, Department of Rheumatology, University Hospital Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.


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