technetium-tc-99m-medronate and Psoriasis

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

A 41-year-old male patient suffering from psoriasis arthropathica underwent a two-phase bone scan for activity of joint affections. Extensive diffuse skin contamination of the extremities in the delayed images was due to the use of the patient's own radioactive urine as an embrocation for psoriasis exanthema.

Topics: Adult; Bone and Bones; Humans; Joints; Male; Psoriasis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

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

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

Patients with rheumatoid arthritis, psoriatic arthritis, and osteoarthritis were assessed by clinical evaluation, radiography, and joint scintigraphy using technetium labelled methylene diphosphonate (MDP) and technetium labelled liposomes. Although both scanning techniques were more sensitive than radiographs in detecting joint disease, the liposomes scans were positive only in clinically active inflammatory disease. In patients with rheumatoid arthritis liposome scintigraphy was also able to discriminate between different grades of joint tenderness. In inactive inflammatory polyarthropathies, although the MDP bone scans continued to show increased activity, the liposome scans did not and were therefore a more accurate reflection of the clinical state. The increased uptake in the liposome scans may be due to incorporation of the liposomes into the phagocytic cells of the synovium. This scan may, therefore, by reflecting the activity of cells involved in the disease process, provide a useful way of assessing disease activity and progression.

Topics: Arthritis; Arthritis, Rheumatoid; Bone and Bones; Hand; Humans; Liposomes; Osteoarthritis; Psoriasis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Bone scintigraphy using 99mTc-EHDP was carried out in 147 psoriatics of both sexes and in 35 nonpsoriatic patients. The psoriatics were subdivided into four groups according to clinical aspects: psoriasis vulgaris (Pv, n = 55), psoriasis inversa (Pinv, n = 32), psoriasis pustulosa of the Königsbeck-Barber type (PpK-B, n = 28), and pustulosis palmaris et plantaris (Ppp, n = 32). The following frequencies of joint involvement were found in the different groups: Pv = 18.3%; Pinv = 22.6%, PpK-B = 11.1%; Ppp = 12.5%; control group 2.3%. In patients suffering from psoriasis vulgaris and psoriasis inversa a pathologic preferential radionuclide uptake was demonstrated in the small peripheral joints of the hands and fingers. The characteristic psoriatic pattern with axial and transverse joint involvement was found in all groups of psoriatic patients. No correlation could be proved between age and pathologic accumulation of the radionuclide or between duration of psoriasis and joint involvement. The so-called anterior chest wall syndrome was found in all patients, but predominantly in those with psoriasis palmaris et plantaris. Finally the indications for bone scintigraphy are discussed.

Topics: Arthritis; Female; Humans; Joints; Keratoderma, Palmoplantar; Male; Middle Aged; Psoriasis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Aged; Clavicle; Diphosphonates; Female; Humans; Male; Middle Aged; Psoriasis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Besides the known joint involvement as seen in the whole-body scan which uses 99m technetium-phosphate-complexes, skeletal scintigraphic investigations in 17 patients with psoriasis have demonstrated circumscribed or diffuse accumulative pathological concentrations of the radionuclide within the skeleton of the skull, the thyroid cartilage, the bony thorax and osseous long bones. These pathological accumulations of radionuclides of TcP-complexes which are distant from joint regions, point to proliferative phenomena in the bone in case of psoriasis especially in alterations of the collagenous metabolism.

Topics: Adult; Aged; Arthritis; Bone Diseases; Diphosphonates; Female; Humans; Male; Middle Aged; Psoriasis; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate

Methodological aspects of quantitative sacroiliac scintigraphy (QSS) using [99mmTc]methylene diphosphonate (MDP) were studied. To improve the diagnostic value of QSS it is important to understand the errors involved in the calculated indices. The accumulated radioactivity in the sacro-iliac joint, compared with that in the sacral bone (SI ratio), decreased linearly with age, by about 24% from the age of 15 years to 71 years. The post-injection time of scintigraphy was not critical, if the scintigraphy was carried out after 2.5 hours. Although the variances of the SI ratios in our control material were relatively high, the repeatability of the SI ratio measurement was 3.9%. The influence of measuring geometry on the QSS and the acceptability of the sacrum as the reference area were tested.

Topics: Adolescent; Adult; Aging; Arthritis, Reactive; Diphosphonates; Female; Functional Laterality; Humans; Male; Methods; Middle Aged; Psoriasis; Radionuclide Imaging; Regression Analysis; Sacroiliac Joint; Sex Factors; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate