technetium-tc-99m-exametazime and Spondylitis--Ankylosing

To study the concordance between abdominal scintigraphy using technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes (ASTLL) and ileocolonoscopy in patients with spondyloarthropathies (SpA) and without clinical evidence of inflammatory bowel disease (IBD).. Fifteen patients with SpA (European Spondylarthropathy Study Group 1991 criteria) without clinical evidence of IBD were studied prospectively with ASTLL and ileocolonoscopy.. This cohort consisted of seven men and eight women aged 31.8+/-10.5 yr (18-47) [mean age +/- S.D. (range)] and with a disease duration of 6.0+/-4.4 yr (0.4-15). ASTLL showed abnormal uptake in four patients. Ileocolonoscopy was abnormal in five patients, showing acute inflammatory lesions in one patient with reactive arthritis, undifferentiated chronic inflammatory lesions in two cases, and features indistinguishable from those of Crohn's disease in two cases. ASTLL was negative in two cases in which ileocolonoscopy showed inflammatory lesions and was positive (terminal ileum) in one case with normal ileocolonoscopy. The concordance between the two examinations was statistically significant (kappa = 0.53; P = 0.008).. ASTLL may be an interesting tool to detect subclinical gut inflammation in patients with SpA.

Topics: Abdomen; Adolescent; Adult; Colonoscopy; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Reproducibility of Results; Spondylitis, Ankylosing; Technetium Tc 99m Exametazime

Gut inflammation is frequent among patients with seronegative spondyloarthropathies (SSp). The purpose of this study was to evaluate the presence of positive abdominal findings in patients with SSp who did not have clinical symptoms or signs of inflammatory bowel disease (IBD). This represents a new indication for abdominal 99mTc-HMPAO-labeled leukocyte scintigraphy.. Eighty-six patients (59 with SSp and 27 controls) were prospectively imaged with 99mTc-HMPAO-labeled leukocytes.. Leukocyte imaging was positive in 33 patients with SSp (56%), 27 of these patients scored between 2+ and 4+ (51%). Four (15%) control patients also had positive findings.. These findings provide evidence linking SSp with intestinal inflammation. SSp may be an important new indication for 99mTc-HMPAO-labeled autologous leukocyte scintigraphy.

Topics: Adult; Arthritis; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Spondylitis, Ankylosing; Technetium Tc 99m Exametazime

Abdominal scintigraphy with technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes is an excellent tool for evaluating disease extent and activity of intestinal lesions in patients with inflammatory bowel disease (IBD). In some cases of seronegative spondylarthropathies (SSp), IBD may remain subclinical. The aim of this study was to evaluate the presence of positive abdominal scintigraphy in patients with SSp and without clinical symptoms or signs of IBD. To this end we studied 32 patients with active SSp (European Spondylarthropathy Study Group 1991 criteria) without clinical evidence of IBD (eight had ankylosing spondylitis, four psoriatic arthritis, three reactive arthritis an 17 undifferentiated SSp) and 11 controls without SSp. All SSp and control patients received similar doses of non-steroidal anti-inflammatory drugs (NSAIDs). Abdominal scintigraphic images were obtained at 30 and 120 min after re-injection of 99mTc-HMPAO-labelled leucocytes. The 99mTc-HMPAO-labelled leucocyte scan was positive in 17 patients with SSp (53.1%) (six with ankylosing spondylitis, three with psoriatic arthritis, two with reactive arthritis and six with undifferentiated SSp). Fourteen patients scored from 2 to 4 on the intensity of uptake scale. The colon and terminal ileum were predominantly involved. Axial involvement was more frequent in patients with a positive scan than in patients with negative results (P<0.05) (64.7% vs 26.6%; odds ratio: 5). No control patient showed a positive scan. It is concluded that 99mTc-HMPAO-labelled leucocyte scan shows increased uptake among patients with SSp without evidence of IBD. These findings provide new evidence linking SSp with intestinal inflammation and suggest that in some cases a bowel-related process could contribute to the development of SSp. Long-term follow-up studies with more patients are necessary to evaluate the diagnostic and therapeutic implications of these results.

Topics: Abdomen; Adult; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Serologic Tests; Spondylitis, Ankylosing; Technetium Tc 99m Exametazime

The aim was to analyse the abdominal scintigraphy pattern in patients with seronegative spondylarthropathy (SSp), ulcerative colitis (UC) and Crohn's disease (CD). A total of 117 patients with defined histological lesions of inflammatory bowel disease (IBD) (68 UC and 49 CD), 32 patients with active SSp [European Spondylarthropathy Study Group (ESSG) 1991 criteria] without clinical evidence of IBD and 21 controls without IBD or SSp were studied. All patients with SSp and controls received similar doses of non-steroidal anti-inflammatory drugs. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of 99m-technetium hexamethyl propylene amine oxime (99mTc-HMPAO)-labelled leucocytes. The 99mTc-HMPAO-labelled leucocyte scan was positive in 17 patients with SSp (53.1%), 45 patients with UC (66.1%) and 33 patients with CD (67.3%). Rectum and sigma involvement was more frequent in patients with UC (68.8%) than in patients with SSp (23.5%) or CD (33.3%) (P < 0.05) [odds ratios (OR): 7.1 and 4.4, respectively]. Terminal ileum involvement was more frequent in patients with CD (63.6%) than in patients with SSp (23.5%) or UC (8.8%) (P < 0.05) (OR: 5.6 and 17.9, respectively). The 99mTc-HMPAO-labelled leucocyte scan shows an increased uptake in patients with SSp without evidence of IBD. Perhaps these patients represent one end of the spectrum of IBD, but rectal and terminal ileum involvement were less frequent in patients with SSp than in patients with UC or CD.

Topics: Abdomen; Adult; Arthritis, Psoriatic; Arthritis, Reactive; Colitis, Ulcerative; Crohn Disease; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Spinal Diseases; Spondylitis, Ankylosing; Technetium Tc 99m Exametazime