Title: Fluorescence imaging technology (FIT) study.
Funder: Department of Health and Social Care

Abstract: Rheumatoid arthritis (RA) is the most common rheumatic chronic inflammatory disease that is characterized by swelling of the joints ultimately leading to joint destruction that often results in pain and disability. RA can strike at any adult age; however, onset most commonly occurs when people are in the prime of their working life. One third of sufferers will have stopped working within two years of onset, and half will be unable to work within ten years. Early diagnosis and successful management of RA is vital in order to get the condition under control before joints become damaged, and to ensure that people with RA remain productive and in work. To achieve this goal, treatment needs to be both started and adapted in a timely fashion. Here, rheumatologists currently face two major diagnostic challenges. The first challenge is the accurate and timely diagnosis of RA in patients with early symptoms to start treatment. Early aggressive therapy significantly improves outcomes in people with RA. The first few months after symptom onset represent a therapeutic window of opportunity, therefore the ability to accurately predict the development of RA in people with very early joint symptoms is of critical importance. The second challenge is the accurate assessment of how people respond to therapy in order to be able to adapt treatment as necessary throughout the disease course. To address these challenges, objective, standardised and accurate diagnostic tools are needed in clinical routine. At present, diagnosis relies heavily on fairly unspecific clinical and laboratory test. Currently, available imaging methods such as MRI and ultrasound are either costly and/or time consuming and therefore not routinely used in clinical practice. Thus, better diagnostic tools for an early accurate diagnosis and monitoring of RA are urgently needed. Fluorescence Imaging Technology (FIT) is a novel automated system for visualization of the hands' microcirculation which reflects inflammation of the joints even when it is not seen by the clinician. FIT was primarily designed to be used for early diagnosis of arthritis and assessment of disease activity. FIT could represent a safe method for identifying changes reflecting inflammation at the hand joints. This procedure is thought to have some very attractive features: it is standardised, technically easy, quick, and convenient for patients.We therefore propose to evaluate the effectiveness and cost-effectiveness of FIT as a point-of-care test in the early diagnosis and management of rheumatoid arthritis to improve outcomes in RA. We will measure the effect of this imaging procedure along with several clinical and blood measures of RA and RA activity as well as with other imaging modalities on overall and health related quality of life. We will also assess how easy and acceptable patients find participation and compliance with the study procedures. If successful, imaging with FIT could represent a well accepted and cost-effective imaging strategy that will aid in the diagnosis, prognosis and evaluation of therapeutic outcome in people with arthritis, with direct benefit for patients with RA.

Lay abstract: Rheumatoid arthritis (RA) is characterized by swelling of the joints ultimately leading to joint destruction that often results in pain and disability. Early diagnosis and successful management of RA is vital in order to get the condition under control before joints become damaged. There is a therapeutic window of opportunity, therefore the ability to accurately predict the development of RA is of critical importance. We propose to asses a novel fluorescence imaging technology (FIT) to assess inflammation of the joints. If successful, FIT could represent a well-accepted imaging strategy with good value for with direct benefit for patients with arthritis.

Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: INFLAMMATORY AND IMMUNE SYSTEM