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

To detect subclinical peripheral arthritis and disease activity in axial seronegative spondyloarthritis (SpA) patients using bone scintigraphy.. Seronegative SpA patients with an established diagnosis and no clinically evident arthritis at the time of the study were included. After excluding symptomatic cases, 20 patients were recruited; 18 with ankylosing spondylitis (AS) and another two with psoriatic arthritis (PsA). Conventional bone scintigraphy was performed to detect the distribution of increased uptake, blood vascular pool (vascularity) and activity.. The peripheral joints in all the patients were asymptomatic with no signs of arthritis on clinical examination. Disease activity was higher in those with hypervascularity and activity (75%) detected by scintigraphy. Scintigraphic activity of the sacroiliac joints was found in 10 patients (50%) with a mean sacroiliac joint index of 2.4 ± 0.6. Subclinical involvement of the hips, knees, shoulders, ankles, small joints of the hands, ankles and sternoclavicular joints, as well as the small joints of the feet were detected with descending frequencies (25%, 25%, 20%, 20%, 15%, 10% and 10%, respectively). Dorsal spine increased uptake was found in 35% and hypervascularity of the skull in two cases. Avascular necrosis of the hip was present in one case with hypovascularity.. The spectrum of joint involvement in seronegative SpAs should not be limited to sacroiliitis. Bone scintigraphy provides a cost-effective method for detecting the extent of involvement in this group of autoimmune systemic diseases (axial SpA) without clinical evidence of peripheral arthritis.

Topics: Adult; Arthritis; Arthritis, Psoriatic; Axis, Cervical Vertebra; Bone and Bones; Cost-Benefit Analysis; Female; Humans; Joints; Male; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Severity of Illness Index; Spine; Spondylarthritis; Spondylitis, Ankylosing; Technetium Tc 99m Medronate

Clinical differentiation of psoriatic arthritis (PsA) and rheumatoid arthritis (rA) based on the pattern of joint involvement can be difficult; the frequent form of PsA with polyarthritis of the peripheral joints may sometime resemble rA. We investigated a metabolic joint asymmetry score (MJAS), reflecting the overall asymmetric joint involvement on conventional bone scintigraphy, for differentiating PsA from rA in patients presenting with peripheral polyarthritis.. 106 patients (n = 61, PsA; n = 45, rA) with peripheral polyarthritis (≥ 5 joints) as well as 26 control subjects with no history of chronic joint disorders were analyzed. The intensity of articular 99mTc-MDP uptake in 40 peripheral joint pairs was scored regarding the bilateral difference of each joint based on a scale of 0-2 (no significant, moderate, and marked asymmetry, respectively). The patient's MJAS was defined as the sum of uptake difference scores of all joint pairs. The association of MJAS with the underlying condition (Psoriasis criteria, Revised Criteria of the ACR) was examined.. 5280 peripheral joint pairs were investigated. There was no significant difference in the total number of involved joints in PsA 15.0 ± 8.2 versus rA 17.5 ± 8.8 patients (p = 0.132), but significantly less involvement in the control group (6.7 ± 5.0, p < 0.001). MJAS was markedly higher in PsA (17.0 ± 9.6) than in rA (4.8 ± 3.9, p < 0.001), and correlated with the total number of involved joints in PsA (r = 0.516, p < 0.001), but not in rA (r = 0.078, p = 0.380). The MJAS disparity between PsA and rA persisted after exclusion of the DIP joints (14.4 ± 7.7 vs. 4.4 ± 3.3; p<0.001).. The new reproducible semi-quantification method for the asymmetry of metabolic joint involvement permits differentiation of psoriatic from rheumatoid peripheral arthritis with MJAS being markedly higher in patients with PsA as compared to rA patients. The score may offer an effective complementary tool for characterizing patients with peripheral polyarthritis.

Topics: Adult; Aged; Arthritis, Psoriatic; Arthritis, Rheumatoid; Bone and Bones; Computer Simulation; Diagnosis, Differential; Female; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Male; Middle Aged; Models, Biological; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Software; Technetium Tc 99m Medronate

Psoriasis and psoriatic arthritis are chronic inflammatory diseases of the skin and joints, but the relationship between them has not been fully understood. Since the delay of treatment for psoriatic arthritis can result in the severe deformities, it is important to identify the pathological triggers of the arthritis. On the other hand, many reports suggest that the changes of immune balance during pre/postpartum period are associated with the state of autoimmune diseases. Here, we report a female case with psoriasis whose arthritis may be triggered by the delivery. Our report suggests that immune tolerance may diminish in the postpartum period, which may alter the susceptibility to arthritis. Female patients should be followed-up carefully during postpartum period against the development of arthritis.

Topics: Adult; Antibodies, Monoclonal; Arthritis, Psoriatic; C-Reactive Protein; Female; Histological Techniques; Humans; Infliximab; Japan; Leukocyte Count; Postnatal Care; Psoriasis; Radionuclide Imaging; Technetium Tc 99m Medronate; Treatment Outcome

Because of a similar tracer accumulation, we assumed to get the same information about synovitis in arthritic joint disease with HIG scintigraphy and bloodpool scintigraphy using HDP. Therefore, we compared retrospectively 23 patients.. In HIG scintigraphy, synovitis was diagnosed according to increasing activity from early to late image. In bloodpool scintigraphy according to an increased activity in comparison to the surrounding tissues.. In 694 joints comparison of both scintigraphic modalities was possible, resulting in a 2 x 2 kappa coefficient of 0.93 or 0.97 by using late-phase bone scintigraphy as an anatomical marker. For intra- and interobserver agreement, 2 x 2 kappa coefficients of 0.93 and 0.88 in HIG scintigraphy, respectively 0.96 and 0.90 in blood-pool scintigraphy were calculated.. This study shows an excellent agreement in the visualization of synovitis by HIG and bloodpool scintigraphy. Because of its higher objectivity and lower cost, investigation of synovitis should be performed by bloodpool scintigraphy.

Topics: Adult; Aged; Arthritis; Arthritis, Psoriatic; Arthritis, Rheumatoid; Bone and Bones; Female; Gamma Cameras; Humans; Immunoglobulins; Lyme Disease; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate

The purpose of this retrospective study was to examine the value of whole-body nuclear medicine imaging and to evaluate the typical scintigraphic pattern of sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO). In this entity the correct diagnosis is frequently missed because of uncharacteristic changes in other imaging modalities.. Forty-nine patients (age range 15-65 years old, mean age 36 years) with sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO) were examined with whole-body scintigraphy and conventional radiography.. Forty-three of 49 patients with SCCH/PAO showed a characteristic "bullhead"-like high tracer uptake of the sternocostoclavicular region with the manubrium sterni representing the upper skull and the inflamed sternoclavicular joints corresponding to the horns (= bullhead sign). Scintigraphy revealed additional skeletal manifestations (spondylitis, sacroiliitis, osteitis) in 33 of 49 patients with SCCH and/or PAO.. Bone scintigraphy is the imaging modality of choice for the diagnosis of skeletal involvement in PAO. Nuclear medicine reveals unexpected locations and shows the typical pattern of focal hot spots of the spine, sacroiliac joints and/or appendicular skeleton in the large majority of cases in combination with a bullhead-like tracer uptake of the sternocostoclavicular region. The bullhead sign is the typical and highly specific scintigraphic manifestation of SCCH and PAO in radionuclide bone scans and helps to avoid unnecessary biopsies.

Topics: Adolescent; Adult; Aged; Arthritis, Psoriatic; Biopsy; Bone and Bones; Diagnosis, Differential; Female; Humans; Hyperostosis, Sternocostoclavicular; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sternoclavicular Joint; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adult; Arthritis, Psoriatic; Bone and Bones; Female; Finger Joint; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Arthritis, Psoriatic; Bone and Bones; Fingers; Humans; Immunoglobulins; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Thumb

Palmoplantar pustulosis (PPP) is often associated with osteoarthritis. The relation between osteoarthritis in PPP and other types of seronegative arthritis remains unclear.. The purpose of this study was to investigate the distribution and the frequency of osteoarthritis in patients with PPP and to compare HLA antigen frequencies in osteoarthritis in PPP, psoriatic arthritis, and ankylosing spondylitis.. Clinical findings were identified and HLA-A, -B, -C, and -DR were determined in 84 Japanese patients with PPP. Bone scintigraphic studies were conducted for forty-one patients.. In addition to the anterior aspect of the chest wall, the knee, spine, and ankle were frequently involved. HLA-DR9 frequency was the highest in patients with PPP who had osteoarthritis.. Involvement of the knees, spine, ankles, and the anterior aspect of the chest wall was noted in patients with osteoarthritis and PPP. Osteoarthritis in PPP seems to be a distinct entity from a genetic point of view.

Topics: Adult; Aged; Arthritis, Psoriatic; Female; HLA-A Antigens; HLA-B Antigens; HLA-C Antigens; HLA-DR Antigens; Humans; Japan; Knee Joint; Male; Middle Aged; Osteoarthritis; Psoriasis; Radionuclide Imaging; Spine; Spondylitis, Ankylosing; Sternoclavicular Joint; Technetium Tc 99m Medronate

Standard bone scintigraphy [using technetium-99m methylene diphosphonate (MDP)] is widely held to be the most sensitive method for the early detection of psoriatic arthropathy. Preliminary results of this study reveal that 99mTc human immunoglobulin (HIG) scintigraphy demonstrates a typical premature pattern of extradermal psoriatic disease in digits indicative of the early stage of psoriatic arthritis. This pattern was also found in a rare case of psoriatic arthropathy without skin lesions. 99mTc-HIG scintigraphy appears to reveal the initial inflammatory characteristics of later bone lesions. In the advanced stage of psoriatic arthritis, 99mTc-MDP and 99mTc-HIG scans were found to be equally sensitive in the detection of the affected joints. Thus 99mTc-HIG scintigraphy seems to be useful in the early detection of psoriatic arthropathy and also in advanced psoriatic arthritis, as well as for the detection of psoriatic arthropathy without skin lesions.

Topics: Arthritis, Psoriatic; Bone and Bones; Fingers; Humans; Immunoglobulins; Radionuclide Imaging; Sensitivity and Specificity; Technetium; Technetium Tc 99m Medronate

Psoriasis is a humorally controlled systemic disease. The degree of "eruptive strength" of manifestation results from hereditary factors (disposition) and environmental factors (provocation). We were able to demonstrate that the well-known Köbner phenomenon of the skin also occurs on the skeleton of patients suffering from psoriasis. We analysed 83 patients in whom bone scans were carried out. Our results indicate that provocation factors such as bacterial foci and/or trauma correlate with a significantly higher number of pathological scintigraphic findings, ranging up to "hot spots". Furthermore, not only did bone fractures remained scintigraphically positive for an unusually long time, traumas of the end phalanx could be demonstrated in 70% of psoriatic patients compared with 21% of a control group. Obviously, one factor alone or a combination of factors triggers the involvement of the skeleton as a "deep Köbner phenomenon". In psoriatic patients the response of bone metabolism to disturbance differs from that of non-psoriatic patients in that there is a long-lasting dysregulation. This explains the high correlation between skin and skeletal manifestation in psoriatics. Therefore the manifestation of psoriatic disease is due not to a single-stranded linear causal interrelation but to a multicausal "network pathogenesis". Bone scintigraphy is the diagnostic method of choice in patients with psoriatic osteoarthropathy and allows an objective evaluation of therapeutic success.

Topics: Adult; Aged; Arthritis, Psoriatic; Bone and Bones; Female; Fracture Healing; Humans; Male; Middle Aged; Psoriasis; Radionuclide Imaging; Risk Factors; Technetium Tc 99m Medronate

Bone scintigraphy is a modern method of low specificity but very high sensitivity in determining early changes in bone metabolism. There is a relationship between excessive skeletal metabolic disorders of the bone and the appearance of foci of maximum radionuclide uptake, or "hot spots". This distribution of radionuclide uptake has a specific character. In a retrospective study, we investigated the distribution of hot spots in 92 patients with various forms of psoriatic disease. Hot spots were found at and near to joints only. In enthesopathies hot spots are not found, because of lack of substance. They do, however, show signs suggesting a major disorder in collagen metabolism. Hot spots indicate a rather acute degree of skeletal involvement in psoriatic disease and are also frequently found in very active phases of psoriatic disease. Therapy-induced regression is possible. Spontaneous regression was observed only in the case of hot spots of short duration. The correlation of scintigraphic findings with X-rays shows that hot spots are signs of maximal focal metabolic activity. In a high percentage of cases they are leading up to a state of destruction, which can be shown on X-rays later. Among other parameters, they indicate the likelihood of skeletal involvement in psoriatic disease. Moreover, they indicate a high risk of "psoriatic arthritis".

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Psoriatic; Bone and Bones; Case-Control Studies; Connective Tissue Diseases; Female; Humans; Ligaments; Male; Middle Aged; Prognosis; Psoriasis; Radionuclide Imaging; Risk Factors; Technetium Tc 99m Medronate; Tendons