indium-oxine and Arthritis--Rheumatoid

To investigate the trafficking of circulating blood neutrophils and synovial fluid neutrophils in rheumatoid arthritis (RA) patients and the influence of a 1,000-mg intravenous pulse of methylprednisolone succinate (MP).. Neutrophils were isolated from the circulation and from the knee synovial compartments of subjects with RA. Circulating neutrophils were labeled with technetium-99 hexametazime (99mTc-HMPAO) and reinjected intravenously. Synovial fluid neutrophils were labeled from indium-111 oxine and reinjected into the knee from which they were isolated. Gamma camera images were obtained at intervals up to 24 hours post MP. Each patient had a baseline study (no MP) and a study in which MP was administered either 4 hours before (2 patients), 10 minutes before (1 patient), or 30 minutes to 1.5 hours after (6 patients) injection of the radiolabeled neutrophils. Subsequent analysis allowed quantitation of the neutrophil uptake into and clearance from the knee as a function of time.. Nine patients who had not received glucocorticoids in the previous 3 months were studied. MP significantly decreased neutrophil ingress in 13 of the 16 knees studied (almost total inhibition in 5 knees), and this occurred within 1.5 hours of MP administration in all except 1 knee. At 24 hours after MP administration, there was a significant increase in visual analog scale (VAS) scores for well-being and significant decreases in scores on the modified Health Assessment Questionnaire (P<0.05), tender joints (P<0.005), VAS for pain (p<0.005), and generalized stiffness (P<0.005), as well as a decrease in the C-reactive protein level (P<0.05). MP had no effect on neutrophil egress (2 patients). Two additional patients who were receiving oral glucocorticoids were studied. One of them was clinically unresponsive to oral prednisolone, and MP had no effect on neutrophil ingress. The other patient showed no neutrophil ingress during the baseline study. This was confirmed by the presence of a noninflammatory synovial fluid at arthrocentesis.. Neutrophil ingress into and egress from inflamed joints can be accurately monitored using radiolabeled neutrophils and quantitative gamma camera imaging. MP rapidly and substantially decreases neutrophil ingress into inflamed joints. In contrast, MP has no effect on neutrophil egress from the joint.

Topics: Aged; Arthritis, Rheumatoid; Cell Movement; Female; Humans; Joints; Male; Methylprednisolone; Middle Aged; Neutrophils; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime

111Indium leucocyte scans were performed on 26 patients with active rheumatoid arthritis. An abnormal localization of radioactivity was observed in the gut of 12 of these patients, generally in the region of the terminal ileum, caecum and ascending colon. No difference was found in the intake of nonsteroidal anti-inflammatory drugs between those with positive and negative scans. Two patients with positive scans were on no medication. These observations suggest the possibility of a primary role for a gastrointestinal lesion in the aetiology of rheumatoid arthritis, although these abnormalities could be secondary or unrelated.

Topics: Adult; Aged; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Female; Humans; Indium; Intestines; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Permeability; Radioisotopes