McGowan Institute faculty member Raphael Hirsch, MD, Division Chief of Rheumatology and Director of Pediatrics Rheumatology Training Program at Children’s Hospital, and also a Professor in the Department of Molecular Genetics/ Biochemistry at the University of Pittsburgh School of Medicine, is assessing joint inflammation in patients using new, high-tech cameras. In his research, thermal cameras are evaluating the pattern of the skin’s temperature, searching for hotspots that can appear around an arthritis patient’s joints. A second camera is being used to take 3-D snapshots of the body so doctors can get a better look at a patient’s joints.
"[Traditionally] we assess a patient in a very subjective way," Dr. Hirsch says. "[Patients] come in, we look at their joints and try to determine if they are abnormal." When diagnosing Juvenile Rheumatoid Arthritis (JRA), Dr. Hirsch says he looks for the four cardinal signs of inflammation: redness, warmth, swelling, and pain. Unfortunately, these symptoms can be difficult to diagnose in children. "Swelling can be a challenge in an 18-month old because they've got a lot of baby fat," he says. "Warmth is also difficult, because it's hard to get an accurate assessment by just using your hand." According to Dr. Hirsch, MRI's and X-rays can be used to diagnose JRA, but MRI's aren't routine since they require the child to be sedated, and X-rays will only show arthritis is present once damage has already been done to the bone.
In his research with the thermal cameras, "What we are finding is how the temperature is distributed across the hand becomes abnormal when you have inflammation," he says. "Normally, the joints are cooler than their surrounding skin, because it's bone. There is less muscle there, whereas if you have arthritis, you get an inversion of that. The joints actually become warmer than the surrounding skin." Three-dimensional cameras are also being used to take detailed pictures of the joints that help doctors assess swelling. "We are now in the process of validating this through some research studies on patients," says Dr. Hirsch. "The idea would be, this could go into the doctor's office and become part of the routine way a patient is evaluated."
"Today, we have some very good medications," he says. "If you can catch these patients early, you can prevent some of the long-term damage to their joints."
Illustration: McGowan Institute for Regenerative Medicine.
News 14 (06/06/07)
ABC Action News (09/23/07)