sodium-pertechnetate-tc-99m and Arthritis--Rheumatoid

Topics: Arthritis, Rheumatoid; Diagnostic Techniques, Endocrine; Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Radiopharmaceuticals; Saliva; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Topics: Arthritis, Rheumatoid; Bone and Bones; Citrates; Diphosphonates; Gallium; Humans; Joints; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Compounds; Tomography, Emission-Computed, Single-Photon

Since the minimal effective dosage for radiosynovectomy is not known, we have performed a doubleblind controlled trial of 1 mCi vs. 5 mCi 198Au in 60 knees of 46 patients with persistent rheumatoid synovitis. The therapeutic effect was assessed with a clinical score, 99mTc pertechnetate uptake measurements and plain X-rays. With regard to clinical parameters no statistical differences between the two groups were found, but results indicate a trend towards a better outcome in patients treated with 5 mCi. 99mTc uptake improved significantly in patients treated with the higher dose and not in the low dose group. Weighing ease of treatment and risk of side effects against the small difference in effectiveness, we conclude that the use of less than 5 mCi of 198Au may be justified. During the study the injection technique was changed, enabling a comparison of two methods. Leakage to lymph nodes and liver decreased when the needle was flushed with normal saline after administration of the radiocolloid.

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Clinical Trials as Topic; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gold Radioisotopes; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Radionuclide Imaging; Random Allocation; Sodium Pertechnetate Tc 99m; Synovitis

Pinhole SPECT can generate sectional nuclear images of a normal and morbid ankle and hindfoot with remarkably enhanced resolution by portraying the topography and pathological alterations in great detail.. Pinhole SPECT was performed using a commercially available single-head, rotating gamma camera system by replacing the parallel-hole collimator used for planar SPECT with a pinhole collimator. The images were reconstructed in the same way as in planar SPECT by using the filtered back-projection algorithm and a Butterworth filter. First, we compared the scan resolution between the planar and pinhole SPECT images of a thyroid phantom and a normal ankle and hindfoot by working out pinhole SPECT anatomy with CT validation. Second, the clinical usefulness was assessed in one case each of fracture, reflex sympathetic dystrophy syndrome and rheumatoid arthritis of the ankle with radiographic correlation. The resolution of the pinhole SPECT and planar pinhole images was compared for these diseases.. The resolution of the pinhole SPECT of a thyroid phantom and of a normal ankle and hindfoot was significantly enhanced compared to the planar SPECT although image distortion was seen in the periphery of the field-of-view. The pinhole SPECT resolution was such that most of the anatomical landmarks were sharply delineated in the ankle and hindfoot and some useful diagnostic signs in the diseased ankle were visible.. Pinhole SPECT can be performed using a single-head gamma camera system and filtered back-projection algorithm. It generates sectional scan images of both normal and morbid ankle and hindfoot with enhanced resolution portraying many anatomical landmarks and pathological signs in useful detail.

Topics: Adult; Algorithms; Ankle; Ankle Joint; Arthritis, Rheumatoid; Female; Fractures, Bone; Heel; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Phantoms, Imaging; Radiopharmaceuticals; Reflex Sympathetic Dystrophy; Sodium Pertechnetate Tc 99m; Talus; Technetium Tc 99m Medronate; Thyroid Gland; Tomography, Emission-Computed, Single-Photon

This study was undertaken to evaluate the use of Indium-111-labeled leukocyte (111In-WBC) imaging compared with Technetium-99m pertechnetate (99mTcO4-) imaging in 19 patients with rheumatoid arthritis (RA) and 8 with osteoarthritis. Knee and wrist joints were evaluated for both radionuclides. The results indicated a good correlation of the clinical assessment of pain and swelling with joint uptake ratio (JUR) between 111In-WBC and 99mTcO4- in RA and osteoarthritis patients. We observed a discrepancy in both imagings in "burned out" cases. It was concluded that a JUR of 111In-WBC could distinguish active RA from inactive RA or osteoarthritis at a value of 1.15 and that the use of 111In-WBC was a more reliable procedure than 99mTcO4-.

Topics: Adult; Aged; Arthritis, Rheumatoid; Female; Humans; Indium Radioisotopes; Knee Joint; Leukocytes; Male; Middle Aged; Osteoarthritis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Wrist Joint

Every doctor faced with the task of testing a drug is well aware of the difficulty of making his or her results objective. In designing test procedures, methods need to be found which are unaffected by the subjective views of either the testing doctor or the patients undergoing the treatment. This study was designed taking this into account, using scintigraphic joint measurements in patients with chronic rheumatoid arthritis (RA) to record comparable data. Even this method, however, despite its indisputable scientific accuracy, requires clinical interpretation.

Topics: Administration, Oral; Adult; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Rheumatoid; Diagnosis, Computer-Assisted; Disability Evaluation; Female; Humans; Joints; Male; Middle Aged; Piroxicam; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

One hundred eight knees of 93 patients with seropositive rheumatoid arthritis and persistent synovitis of the knee were treated with an intraarticular injection of 270 mCi of dysprosium 165 bound to ferric hydroxide macroaggregate. Leakage of radioactivity from the injected joint was minimal. Mean leakage to the venous blood 3 hours after injection was 0.11% of the injected dose; this corresponds to a mean whole body dose of 0.2 rads. Mean leakage to the liver 24 hours after injection was 0.64% of the injected dose; this corresponds to a mean liver dose of 3.2 rads. In 7 additional patients examined, there was negligible or near negligible activity found in the draining inguinal lymph nodes. One-year followup was possible for 74 knees (63 patients). Sixty-one percent of the knees had good results, 23% had fair results, and 16% had poor results. There was a direct correlation between the radiographic stage and response to treatment. In knees with stage I radiographic changes, 72% showed good results; 93% showed improvement. In knees with stage II changes, 59% showed good results; 81% showed improvement. These preliminary results indicate that dysprosium 165-ferric hydroxide macroaggregate is an effective agent for radiation synovectomy. The low leakage rates observed offer a definite advantage over agents previously used.

Topics: Adult; Aged; Arthritis, Rheumatoid; Dysprosium; Evaluation Studies as Topic; Female; Ferric Compounds; Follow-Up Studies; Half-Life; Humans; Injections, Intra-Articular; Iron; Knee Joint; Liver; Lymph Nodes; Male; Middle Aged; Pilot Projects; Radioisotopes; Radionuclide Imaging; Radiotherapy Dosage; Sodium Pertechnetate Tc 99m; Synovitis; Time Factors

The majority of severe haemophiliacs will develop a crippling arthritis consequent upon recurrent haemarthroses although the pathogenic mechanism remains unclear. We have carried out technetium-99 pertechnetate joint scans in the elbows, knees and ankles of 23 haemophilic patients and compared the isotope uptake of the 15 patients with clinical and radiological evidence of arthritis to that of eight patients without arthritis, to 13 age-matched healthy male controls, and to 10 age-matched males with active rheumatoid arthritis. Isotope uptake into the knee joints was significantly higher in haemophilic arthritis than in controls, haemophiliacs without arthritis, and patients with rheumatoid arthritis [median percentage uptake of administered technetium (Tc) dose X 10(3) in right knee = 9.4, 6.2, 6.4 and 6.6, respectively]: and the differences from haemophilic arthritis were all significant (p less than 0.01, Mann-Whitney U test). Similar differences were seen in the elbows and ankles. Increased Tc uptake correlated strongly with frequency of haemarthrosis, pain, synovitis, range of movement and radiological changes in knees and elbows, but poorly with the lesser changes seen in the ankles. These results would support the theory that haemophilic arthritis amongst the inflammatory arthropathies and that scanning is an appropriate technique for following progression of joint disease.

Topics: Ankle Joint; Arthritis; Arthritis, Rheumatoid; Elbow Joint; Hemophilia A; Humans; Joints; Knee Joint; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

In 22 patients with rheumatoid arthritis oral ticlopidine 250 mg/day for 18 months induced clinical improvement, confirmed by a significant decrease in the counts of involved joint. A significant decrease was observed in the technetium index (Tc-index) and the erythrocyte sedimentation rate (ESR), and a significant increase occurred in the serum sulphydryl (SH) levels. The long-term changes in serum SH and Tc-index produced by ticlopidine may represent a specific antirheumatic activity of this platelet-inhibiting drug.

Topics: Adult; Aged; Arthritis, Rheumatoid; Blood Sedimentation; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Sulfhydryl Compounds; Thiophenes; Ticlopidine

99mTc-polyphosphate joint imaging of the hand has been performed in 18 patients, with evidence of inflammatory joint disease, but without any significant radiographic lesions, which might be related to rheumatoid arthritis. The hand scans were compared to clinical and radiographic data. An year after, the same subjects were re-examined, with both the radionuclide imaging and radiography. Scintigraphy has been shown to be significantly more sensitive for detecting inflammatory joint disease than x-ray, especially in the early stage of rheumatoid arthritis. Although radionuclide imaging is non specific (activity is increased also in osteoarthritis, trauma, metabolic bone disease, infarction, etc.). Radiography is highly specific but relatively non sensitive.

Topics: Adult; Aged; Arthritis, Rheumatoid; Diagnosis, Differential; Diphosphates; Diphosphonates; Female; Hand; Humans; Male; Middle Aged; Polyphosphates; Radiography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Compounds; Technetium Tc 99m Pyrophosphate

Computerized, quantitative joint scintigraphies were performed using both 99mTc-MDP and 99mTc-pertechnetate. 17 joint pairs with asymmetric active arthritis were selected for the study. The joint activity ratio was calculated by dividing the curve peak value of the inflamed joint by the curve maximum of the contralateral symptomless joint. A very high joint activity ratio with 99mTc-MDP was observed in the case of septic arthritis with osteolytic lesions. In all the rheumatoid joints the activity ratios were higher with 99mTc-MDP than with 99mTc-pertechnetate. In reactive arthritis the mean joint activity ratio was equal with both tracers. It appears that 99mTc-MDP is more sensitive in detecting active rheumatoid arthritis than 99mTc-pertechnetate and that high 99mTc-MDP values might be prognostic of destructive changes.

Topics: Arthritis; Arthritis, Rheumatoid; Diphosphonates; Humans; Joints; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Arthritis, Rheumatoid; Female; Humans; Joints; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Twenty-eight knees with chronic arthritis and effusion were treated with intra-articular 90Y. Synovial activity was assessed by measuring 99mTc pertechnetate uptake. There was a significant difference in uptake between controls and patients. Those who had a good response to 90Y (15 patients) showed a significant decrease in uptake, not seen in those who failed to respond. The pattern of 90Y distribution was examined and appeared to correspond to areas of increased synovial activity; these patterns and their significance have not been previously reported. Factors which could help to predict response to 90Y are discussed.

Topics: Aged; Arthritis, Rheumatoid; Female; Humans; Knee Joint; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Synovitis; Technetium; Yttrium Radioisotopes

Ten patients with rheumatoid arthritis were given piroxicam in a single daily dose of 20-40 mg for 16 weeks. The average number of painful joints decreased from 16.7 to 4.0. Similar reductions were seen in the number of inflamed joints and number of tender joints. Scintigraphic study of the patients revealed a clear reduction in 99TC uptake suggesting significant anti-inflammatory activity of the drug.

Topics: Anti-Inflammatory Agents; Arthritis, Rheumatoid; Female; Humans; Joints; Male; Piroxicam; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thiazines; Time Factors

In 6 out of 48 non-hinged knee joint replacements in 35 patients, 99mTc04- uptake values were clearly increased compared with a control group. Measurements were performed an average of 3 years (range 9 months - 4 1/2 years) after operation. Four of the six cases showed loosening of the prosthesis at arthrotomy and one showed an infection. Tests for hypersensitivity to the different components of the prosthesis and cement were normal. Histology and immunofluorescence of the synovial membrane obtained at arthrotomy in the four operated patients showed no recurrence of the synovitis. This study indicates that there is no recurrence or only a slight recurrence of rheumatoid synovitis after total knee joint replacement of the geometric type.

Topics: Aged; Arthritis, Rheumatoid; Female; Follow-Up Studies; Humans; Knee Prosthesis; Male; Middle Aged; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Synovial Membrane; Synovitis; Technetium; Time Factors

Serum enzymes and articular radionuclide tests have a restricted application in solving the current diagnostic and differential-diagnostic problems of present-day rheumatology. The enzyme tests became positive in case of a high activity of rheumatoid arthritis, not objectivizing the articular degeneration. Their correlation with radionuclide tests of the patients with osteoarthrosis and the patients with rheumatoid arthritis is not elucidated. A juxtaposition was made of the serum enzymes with the articular radionuclide quantitative indices in 88 patients with rheumatoid arthritis with various clinical-laboratory activity, 88 patients with osteoarthrosis in various X-ray stages and 22 healthy controls. A correlation dependence was established between LDH, CPK, acid phosphatase, clearance effectiveness of articular cavity and the deposition of 99mTc-pyrophosphate in knee joints of the patients with osteoarthritis and between gamm-GT, alkaline phosphatase, acid phosphatase and radionuclide articular indices of the patients with rheumatoid arthritis. Those characteristics enabled the earlier overcoming of the diagnostic difficulties in those two basic rheumatic diseases.

Topics: Adult; Arthritis, Rheumatoid; Clinical Enzyme Tests; Diphosphates; Enzyme Activation; Humans; Knee Joint; Middle Aged; Osteoarthritis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate; Xenon Radioisotopes

Topics: Arthritis, Rheumatoid; Diagnosis, Computer-Assisted; Diphosphonates; Humans; Joints; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Synovitis; Technetium; Technetium Tc 99m Medronate

Topics: Ankle Joint; Arthritis, Rheumatoid; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Wrist Joint