title: Tc-99m sestamibi lower extremity muscle scan, is it a useful screening tool for assessment of preclinical atherosclerosis in rheumatoid arthritis patients?
abstract: Increased cardiovascular morbidity and mortality in rheumatoid arthritis (RA) patients cannot be entirely explained by traditional risk factors, suggesting that systemic inflammation characterizing this disease may accelerate atherosclerosis. Technetium 99m-Methoxyisobutyl isonitrile (Tc-99m sestamibi) is a myocardial perfusion imaging agent that has been suggested for evaluation of peripheral vascular disease. We used Tc-99m sestamibi muscle scan to investigate the prevalence of preclinical atherosclerosis in RA patients by perfusion reserve (PR) measurement. This study included 25 RA patients and 25 controls; 13/25 RA (GII) were on glucocorticoids and 12/25 (GI) were not. Database included full history, clinical examination, relevant laboratory tests, and Tc-99m sestamibi muscle scan for lower limbs. The percentage increase in the total counts (Cts) in the exercising calf termed PR was calculated according to the formula: (PR %) = (Cts in exercising calf-Cts in resting calf) ÷ (Cts in resting calf) × 100%. A significant difference was found between the means of PR in RA and controls (30.7±22.6% vs. 48.3±27.2%, P = 0.015). The mean perfusion reserve of GII correlated significantly with the steroids cumulative dose (P = 0.01). A statistically significant negative correlation was elicited between PR and disease duration (P = 0.024), while the negative correlation between PR and Disease Activity Index (DAS28) was not statistically significant (P = 0.065). Tc-99m sestamibi lower-limb muscle scan could be a useful screening tool for detection of preclinical atherosclerosis in lower limbs of RA patients, so early prophylactic measures and therapy modifications could be considered.
authors.affiliation: Department of Nuclear Medicine, Faculty of Medicine, Cairo University, 32, Soliman Abaza St. Al-Mohandeseen, Giza, Egypt. amramin67@gmail.com
authors.forename: Amr M
authors.initials: AM
authors.lastname: Amin
authors.forename: Zeinab O
authors.initials: ZO
authors.lastname: Nawito
authors.forename: Rania A
authors.initials: RA
authors.lastname: Atfy
authors.forename: Khaled T
authors.initials: KT
authors.lastname: El-Hadidi
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D050197:Atherosclerosis / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000187:drug effects; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi