The United Nations has proclaimed the years 2001-2010 as the Bone and Joint Decade. This global initiative is intended to improve the lives of people with musculoskeletal disorders, such as arthritis, and to advance understanding and treatment of musculoskeletal disorders. In the United States musculoskeletal complaints (including arthritis) are the leading category of reported chronic impairment and also rank at the top in terms of visits to physicians - more than 130 million patient visits, costing $215 billion were recorded in 1995 alone. The World Health Organization estimates a doubling in the number of people that suffer from bone and joint diseases by 2020.
Imaging of rheumatoid arthritis (RA) in finger joints was the first clinical project to be funded in Prof. Hielscher's laboratory and is still has a central place in many endeavors. RA is a chronic, progressive, systemic, inflammatory disease that primarily attacks peripheral joints and surrounding tendons and ligaments. This disease, associated with significant pain and disability, affects about 1% of the population worldwide, and approximately 2.1 million people in the US. Women are about three to four times as likely as men to develop RA. While RA can be mild, 10% of affected subjects suffer total disability. Furthermore, there are indications that patients with RA die earlier, even though the immediate causes for death appears similar to those of the general population.
Beside the clinical significance of this problem, this project is a perfect match for the hardware and software expertise in the BORA laboratory. The small geometries of fingers allow for a strong signal-to-noise ratio and at the same time require ERT models of light propagation. Using instruments and codes developed by Prof. Hielscher's teram, it was possible to show that joints affected by RA have a distinct optical signature (Hielscher et al, Phys Med Bio 49(7), 1147 - 1163, 2004). Using these results, another 4 years of funding from NIAMS was secured in September 2004. The BORAL team will now perform studies with larger patient groups and compare the optical findings with MRI, US imaging, and general clinical tests. This project involves collaborators at Columbia’s Medical School, the Charité Medical University in Berlin, Germany, and the Georg-August University in Göttingen, Germany. Looking at static as well as hemodynamic measures, these studies should provide an ultimate answer concerning the contrast mechanisms involved in optical tomographic imaging of joints, and prove the clinical utility of this method.
The techniques and systems to be developed under this project are by no means limited to imaging RA in finger joints. Once the contrast mechanism are fully understood and characterized for this case, the technology is easily extended to other areas. Examples are psoriatic arthritis, osteoarthritis, systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD). Bone tumors and muscle atrophy are other areas of potential interest. Beyond the finger, OT reconstructions can be attempted of the wrist, elbow, shoulder, knee and feet. Especially the knee would be of interest, given the large number of sports injuries. Imaging the hip and the spine will be more challenging (but not impossible) since these joints and bones cannot be surrounded by source and detectors. How the larger dimensions of all these joints affect the reconstructions results needs to be seen.
laboratory and is still has a central place in many endeavors. RA is a chronic, progressive, systemic, inflammatory disease that primarily attacks peripheral joints and surrounding tendons and ligaments. This disease, associated with significant pain and disability, affects about 1% of the population worldwide, and approximately 2.1 million people in the US. Women are about three to four times as likely as men to develop RA. While RA can be mild, 10% of affected subjects suffer total disability. Furthermore, there are indications that patients with RA die earlier, even though the immediate causes for death appears similar to those of the general population.