technetium-tc-99m-medronate and Arthritis--Juvenile

Topics: Arthritis, Juvenile; Bone and Bones; Child; Drugs, Chinese Herbal; Humans; Liver; Male; Radionuclide Imaging; Spleen; Technetium Tc 99m Medronate

We reviewed the medical records and technetium bone/joint scans of 160 children presenting to the inpatient Pediatric Rheumatology service over a 3-year period. When the scan result (normal versus abnormal) was considered for each patient as a whole, scan sensitivity and specificity were both approximately 75%. However, when each joint was considered individually, sensitivity decreased to 37%, while specificity rose to more than 95% when compared to clinical examination. Reasons for these variations and their clinical correlation are discussed. Overall, radionuclide bone/joint scanning was found to be very useful in the evaluation of monoarticular and nonrheumatic disorders, but it did not alter therapy in children with known connective tissue disorders or other polyarticular diseases.

Topics: Adolescent; Arthritis; Arthritis, Juvenile; Bone and Bones; Child; Child, Preschool; Female; Humans; Infant; Joint Diseases; Joints; Male; Radionuclide Imaging; Rheumatic Diseases; Spinal Diseases; Technetium Tc 99m Medronate

A 46-year-old woman was admitted to our hospital because of fever of unknown origin. Her fever continued with a daily rise to around 38 degrees C to 40 degrees C for more than six months, occasionally accompanied by polyarthralgia, erythematous rash and cervical lymphadenopathy. The erythrocyte sedimentation rate was 75 mm per hour and CRP was over 6+. The white-cell count was 15,100 with 21 percent band forms and the alpha 2-globulin was 18.8 percent of total protein. The tests for autoantibodies were negative. Clinical course and laboratory findings in this case were most compatible with adult Still's disease. A radionucleotide bone scan with 99mTc showed a greatly increased uptake of the radionucleotide at the large joints of the whole body, and a gallium scan also revealed accumulation of the radionucleotide at the bone marrow of the sternum. These findings were recognized during high fever and disappeared when the body temperature returned to normal. These examinations might be useful for investigating the active site of inflammation and for studying the pathogenesis of adult Still's disease.

Topics: Arthritis, Juvenile; Bone and Bones; Female; Fever of Unknown Origin; Gallium Radioisotopes; Humans; Joints; Middle Aged; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate