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

Three patients with reactive arthritis and 2 with ankylosing spondylitis resistant to therapy with nonsteroidal antiinflammatory drugs were treated with enteric coated sulfasalazine in an open trial. Significant toxicity was not observed; 1 patient discontinued sulfasalazine because of gastrointestinal symptoms. As a group, statistically significant improvement was observed in 50 foot walk time, morning stiffness, and hemoglobin concentration. One patient went into complete clinical remission, 2 improved, 1 showed no change, and 1 worsened. Asymptomatic colonic inflammation was found in each of 4 patients examined before beginning therapy. Changes in bowel pathology did not parallel changes in joint symptoms. Sulfasalazine may be a safe and useful therapeutic modality in patients with chronic reactive arthritis or ankylosing spondylitis.

Topics: Adolescent; Adult; Arthritis; Female; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Spondylitis, Ankylosing; Sulfasalazine; Technetium Tc 99m Medronate

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

Juvenile-onset ankylosing spondylitis is an unusual disorder which can present with either peripheral arthritis or more classic hip girdle and back symptoms. A 12-year-old child with this disease was admitted with walking disorder, cervical pain, restricted cervical motion, and right ankle swelling. Diffusely increased accumulation of radioactivity in the cervical spine, focally increased accumulation in bilateral sacroiliac joints, and diminished irregular uptake in thoracal spine were detected on technetium 99m methylene diphosphonate bone scintigraphy. As a result, this imaging technique may give important information for diagnosis and differential diagnosis in juvenile chronic arthritis.

Topics: Cervical Vertebrae; Child; Gait; Humans; Movement Disorders; Radionuclide Imaging; Radiopharmaceuticals; Spondylitis, Ankylosing; Technetium Tc 99m Medronate

Topics: Adult; Ankylosis; Diagnosis, Differential; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Spondylitis, Ankylosing; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders

Topics: Antibodies, Monoclonal; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Humans; Infliximab; Infusions, Intravenous; Male; Middle Aged; Monitoring, Physiologic; Radionuclide Imaging; Sensitivity and Specificity; Spondylitis, Ankylosing; Technetium Tc 99m Medronate; Treatment Outcome

Topics: Adult; Cervical Vertebrae; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Spondylitis, Ankylosing; Technetium Tc 99m Medronate; Thoracic Vertebrae

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

Bone SPECT has acquired a useful role in the evaluation of acute and chronic back pain. Spinal pain is also a characteristic of chronic ankylosing spondylitis. The authors investigated the bone SPECT appearances of the lower thoracic and lumbar spine in 28 symptomatic patients with established ankylosing spondylitis, half of whom had complete ankylosis of the sacroiliac and one third complete ankylosis of the intervertebral joints. SPECT abnormalities were identified in 89%. Facetal joint uptake was found in 16 (57%) patients, of whom 7 (25%) had three or more, and 2 (7%) had seven or more active sites. The only other common site of uptake was in the vertebral body, in which 15 patients (54%) showed increased uptake with three or more sites found in 3 (11%) patients. The authors conclude that SPECT abnormalities in the lower thoracic and lumbar spine are frequently found in patients with ankylosing spondylitis, with the most common sites of abnormality in the facetal joints or vertebral body. Multiple sites of uptake in the facetal joints maybe striking in such patients and has not been previously described.

Topics: Adult; Female; Humans; Lumbar Vertebrae; Male; Radiopharmaceuticals; Spondylitis, Ankylosing; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

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

99mTechnetium-MDP bone scintigrams in 11 patients with ankylosing spondylitis were reviewed. Increased activity in sacroiliac joints was present in five of 11 cases, all of whom had symptoms of less than 5 years duration. Patients with longstanding disease had normal or low sacroiliac joint activity. In the spine, appearances included diffuse symmetrical, unifocal or multifocal asymmetrical increased uptake involving the costovertebral, costotransverse and facet joints as well as the spinous processes. In advanced disease with extensive ankylosis, the lumbar spine was featureless on scintigraphy, except for focal increased activity at the site of previous fracture in one patient. Of six available views of the sternum, increased uptake was present in five at the manubriosternal joint and five at the sternoclavicular joints. Increased peripheral uptake was mainly in the hips and knees in advanced cases. Plain radiographic changes correlated poorly with scintigraphic changes, scintigraphy detecting considerably more lesions than radiography. Awareness of the scintigraphic appearances of ankylosing spondylitis may lead to diagnosis before the development of radiographic changes and avoid confusion with other pathology. Clinical indications for bone scintigraphy in ankylosing spondylitis are suggested.

Topics: Adult; Female; Hip Joint; Humans; Joints; Knee Joint; Male; Manubrium; Middle Aged; Radiography; Radionuclide Imaging; Sacroiliac Joint; Spine; Spondylitis, Ankylosing; Sternoclavicular Joint; Sternum; Technetium Tc 99m Medronate; Time Factors

A method for applying 99mTc-MDP for dynamic and static quantitative radioisotope scanning (QRS) of the sacroiliac joints (SI) in early progressive sacroiliitis in ankylosing spondylitis (AS) is described. In a prospective study, 2 groups of male AS patients were investigated, one with increased elevated erythrocytic sedimentation rate (ESR) (group A, n = 7) and one with normal ESR (group B, n = 8). In both groups an increased uptake of the radiotracer was found in the static part of the study versus a control group C (n = 9). An increased uptake versus group C was also found for group A in the dynamic part of the study (p = 0.01) while there was no significant difference dynamically between groups B and C. The results of the dynamic study in group A indicate ESR to be a parameter of inflammatory activity in the SI joints. The study also seems to indicate QRS to be a valuable diagnostic method in early AS without definite radiographic changes in the SI joints.

Topics: Adult; Blood Sedimentation; Humans; Male; Prospective Studies; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium Tc 99m Medronate

A patient with AA amyloidosis secondary to ankylosing spondylitis showed intense liver uptake of Tc-99m MDP on bone imaging. The biopsy showed hepatic amyloid deposition. A repeat bone scan with Tc-99m MDP 1 year later was negative, although the clinical signs and liver function tests of the patient had not changed. A mechanism might exist, other than the affinity of amyloid to calcium, which would explain the extraosseous uptake of pyrophosphates and diphosphonates in organs and soft tissues affected by systemic amyloidosis.

Topics: Amyloidosis; Diphosphates; Humans; Liver; Liver Diseases; Male; Middle Aged; Radiography; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Single Photon Emission Computed Tomography (SPECT) has been used to examine the spine in a prospective long-term study with the aim of assessing the value of bone scintigraphy in the detection and diagnosis of ankylosing spondylitis (AS). Sites of increased uptake of 99Tcm-MDP were observed in three of the eleven patients examined so far. By carefully optimising the SPECT system (rotating gamma camera), as well as the examination procedure, with respect to high spatial resolution, it was possible to relate these sites precisely to anatomical sites in sectional images of the spine. The advantages of SPECT are demonstrated in all three cases in which the areas of increased uptake in sagittal and transverse sections can be related to specific anatomical sites of the spine characteristically affected by AS. The findings in each of these cases are quite distinct from those of a normal case and correlate with the radiographic appearances. It is concluded that SPECT will make it easier to observe, localise and evaluate regions of increased uptake in patients with AS compared with conventional scintigraphy.

Topics: Adult; Diphosphonates; Female; Humans; Lumbar Vertebrae; Male; Spine; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed

Various authors have advocated quantitative methods of evaluating bone scintigrams to detect sacroiliitis, while others have not found them useful. Many explanations for this disagreement have been offered, including differences in the method of case selection, ethnicity, gender, and previous drug therapy. It would appear that one of the most important impediments to consistent results is the variability of selecting sacroiliac joint and reference regions of interest (ROIs). The effect of ROI selection would seem particularly important because of the normal variability of radioactivity within the reference regions that have been used (sacrum, spine, iliac wing) and the inhomogeneity of activity in the SI joints. We have investigated the effect of ROI selection, using five different methods representative of, though not necessarily identical to, those found in the literature. Each method produced unique mean indices that were different for patients with ankylosing spondylitis (AS) and controls. The method of Ayres (19) proved superior (largest mean difference, smallest variance), but none worked well as a diagnostic tool because of substantial overlap of the distributions of indices of patient and control groups. We conclude that ROI selection is important in determining results, and quantitative scintigraphic methods in general are not effective tools for diagnosing AS. Among the possible factors limiting success, difficulty in selecting a stable reference area seems of particular importance.

Topics: Adult; Aged; Arthritis, Rheumatoid; Diphosphonates; Female; HLA Antigens; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Technology, Radiologic

Topics: Adult; Aged; Arthritis, Reactive; Diphosphonates; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Sacrum; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate

To evaluate clinical usefulness of quantitative sacroiliac scintigraphy (QSS) in detecting sacroiliitis, we used a modified, pixel by pixel technique for calculating sacroiliac joint/sacrum uptake ratios (sacroiliac joint index - SII). We studied 90 controls, 18 selected patients with active sacroiliitis, 2 ankylosing spondylitis patients with completely ankylosed sacroiliac joints, 14 patients with nonspecific low back pain and 5 patients with rheumatoid arthritis. In the controls, we found that the SII decreases with increasing age (P less than 0.001) and is higher in males than in females (P less than 0.005). In the patients with active sacroiliitis, 9 out of 14 older than 30 had an abnormal SII; 3 of these patients showed no radiographic or CT abnormalities of the sacroiliac joints. None of the 4 patients with sacroiliitis under 30 years of age had values which fell out of the normal range for their age and sex. Only 1 of the 14 patients with non-inflammatory low back pain had an abnormally high SII. A borderline SII was found in 1 of the 5 patients with rheumatoid arthritis. QSS may be useful in detecting active sacroiliitis, sometimes even before the occurrence of radiologic abnormalities. However, because of its low sensitivity, its clinical usefulness is limited, especially in patients under 30 years of age.

Topics: Adolescent; Adult; Arthritis; Arthritis, Rheumatoid; Diphosphonates; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Radionuclide joint imaging with the technetium-99m-labeled phosphates is a sensitive technique for the detection of inflammatory articular disease, although it is nonspecific as to the cause of the increased uptake and offers poor resolution in comparison to conventional radiography. There does not appear to be any place for the routine use of joint imaging of the peripheral joints, as there is little evidence that it benefits patient management. Scintigraphy is of benefit in the detection of osteomyelitis, Legg-Perthes' disease, and osteonecrosis, where changes may antedate roentgenologic abnormalities. Technetium-99m-phosphates may have an increasing role in the evaluation of knee and hip prosthetic joint loosening and infection, especially regarding the femoral components. Scintigraphy may be useful in excluding synovitis and allaying concern in selected patients with chronic articular pain in whom a conventional diagnostic evaluation is unrewarding. Attempts have been made to use radionuclide joint imaging to quantitate the degree of synovitis present in individual joints, particularly the sacroiliac joints. To date, reliable methods that distinguish normal from abnormal joints have not been established, although this remains an area of potential usefulness and active research. Scintigraphy with 99mTc-phosphates is useful in the detection of spinal fracture and pseudoarthrosis in individuals with ankylosing spondylitis.

Topics: Adult; Arthritis; Bone Neoplasms; Child; Diphosphates; Diphosphonates; Female; Gallium Radioisotopes; Humans; Joint Diseases; Legg-Calve-Perthes Disease; Male; Middle Aged; Osteoarthritis; Osteomyelitis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spondylitis, Ankylosing; Synovitis; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

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

Since ankylosing spondylitis (S.a.) tends to be milder and less progressive in women than in men, there are great difficulties in diagnosing S.a. in female patients. The role of scintiscanning for investigation of S.a. in women is discussed by few examiners only, especially there are no investigations of quantitative sacroiliac scintigraphy in large groups of female patients. Quantitative sacroiliac scintigraphy was performed in 19 female patients with S.a. and in 30 control subjects. The sacroiliac/sacrum ratio (Index ISG/sacrum) was calculated. Significantly increased uptakes were found in the patient group compared with the controls. Especially in the early periods of S.a. the activity index was highest. When history and physical examination lead to a suspicion of S.a. and there is no verification by roentgenographic studies, sacroiliac joint scintigraphy is indicated. If clinical and laboratory findings are respected in each patient, quantitative sacroiliac scintigraphy is useful for the early diagnosis of S.a. in female patients.

Topics: Adult; Diphosphates; Diphosphonates; Female; Humans; Middle Aged; Radiography; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Bone scintigraphs in a case of ankylosing spondylitis exhibiting a characteristic involvement of sternal and spinal joints are described and discussed.

Topics: Bone and Bones; Diphosphonates; Humans; Joints; Male; Middle Aged; Radionuclide Imaging; Spondylitis, Ankylosing; Sternocostal Joints; Technetium; Technetium Tc 99m Medronate

99m technetium methylene diphosphate was used for whole body scanning and linear multiplane tomoscanning in 10 patients with typical clinical symptoms of prolapsed disc, in order to investigate whether there would be an increased focal accumulation corresponding to the bone structures adjacent to the affected disc. The diagnosis of a prolapsed disc was confined by amipaque myelography, carried out in 9 patients, and finally verified at operation. In none of the 10 cases could accumulation of radioactivity in the bony structures of the affected lumar segment be demonstrated. Consequently this method has not been adopted for the diagnosis of prolapsed lumbar discs. However it was demonstrated that 99m technetium methylene diphosphate scintillography is useful in the differential diagnosis of anchylosing spondylitis and discitis.

Topics: Adult; Diagnosis, Differential; Diphosphonates; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Myelography; Radionuclide Imaging; Spondylitis; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate