technetium-tc-99m-exametazime and triamcinolone-hexacetonide

The synovial and bone uptake of tracer in the knees of patients with rheumatoid arthritis (RA) was quantified using 99Tcm-hexamethyl propylene amine oxime-labelled leucocytes and 99Tcm-methylene diphosphonate (MDP), respectively. Significant neutrophil migration and MDP uptake occurred in the knees of patients with RA irrespective of the disease duration. In all but one patient neutrophil migration was reduced after intra-articular steroid injection. The change in MDP uptake after steroid injection was variable. There was a significant correlation between the percentage reduction in neutrophil migration and pain score, while the latter correlated poorly with the change in MDP uptake. The quantification of the neutrophil component of the inflammatory process is a sensitive index for monitoring RA activity and response to pharmacological interventions, while quantitative bone scintigraphy should not be employed to monitor changes in joint inflammation in patients with RA.

Topics: Aged; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Cell Movement; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Neutrophils; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Triamcinolone Acetonide

We quantitated in vivo migration of neutrophils into the knees of patients with rheumatoid arthritis (RA) and osteoarthritis, using 99mtechnetium-hexamethyl-propylene-amineoxime-labeled leukocytes and gamma scintigraphy. Significant neutrophil migration occurred in patients with RA irrespective of disease duration, and it was reduced by 60% following intraarticular steroid injection. The reduction in neutrophil migration correlated with reduction in pain. Leukocyte migration into osteoarthritic joints was also demonstrated, although it was much less than that seen in rheumatoid joints. No significant leukocyte migration into the joints of patients without arthritis was demonstrated. This technique appears to provide a sensitive method for quantitatively assessing the neutrophil component of inflammation in individual joints of patients with arthritis.

Topics: Adult; Aged; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Cell Movement; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Neutrophils; Organotechnetium Compounds; Osteoarthritis; Oximes; Pain; Radionuclide Imaging; Technetium Tc 99m Exametazime; Triamcinolone Acetonide