title: Radionuclide imaging with human polyclonal immunoglobulin (Tc-HIG) and bone scan in patients with rheumatoid arthritis and serum-negative polyarthritis.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) is a chronic polyarthritic syndrome in which actively inflamed joints coexist with others being in remission. Compatible bone scan (BS) reveals joints with increased activity due to degenerative alterations, whilst scanning with human polyclonal immunoglobulin (HIG) is capable to show which of the joints present active inflammation of the synovial membrane. The aim of the study is to investigate the utility of molecular imaging with HIG in patients suffering from RA.
  
  
  METHODS
  Forty patients (9 males plus 31 females), suffering from painful polyarthritic syndrome, with a mean age 45.3±7 years and a duration of disease 18.3±4.2 months were enrolled in the study. Twenty-six of the patients were serum positive to RA factor, considered as suffering from RA, whilst fourteen of them were RA factor negatives and they were considered as patients with serum-negative polyarthritis. All patients were submitted to x-rays and ultrasound examination (US) in joints of interest, plus whole body BS with (99m)Tc-MDP and finally scan with (99m)Tc-HIG.
  
  
  RESULTS
  A total of 1680 joints have been evaluated. In 6 of the patients-two with serum negative RA (252 joints), radionuclide imaging with HIG was within normal limits, despite the fact that in compatible bone scan degenerative alterations have been mentioned in 30 joints. In all these patients disease was evaluated as inactive ("arthrotic changes"). In the remaining 34 patients-12 with serum negative RA (1428 joints), increased accumulation of HIG, concerning serum positive patients, has been mentioned to 163 joints ("arthritic changes"), whilst in the same group, BS revealed degenerative changes to 265 joints. Concerning serum negative patients, the respective results were 64 versus 190 joints. Increased uptake of HIG has been found in 189/226 swollen and painful joints (overall sensitivity according to clinical criteria 83.3%) and in 38 joints without any clinical evidence of inflammation, with clinical active inflammation presented after follow-up to 35 of them, yielding thus specificity at the level of 92%. Matched findings between these two methods have been mentioned to 185 out of 227 joints with an abnormal scan with HIG. Abnormal x-rays and US findings have been mentioned in 67 of the joints.
  
  
  CONCLUSIONS
  According to the above mentioned, BS in RA reveals joints being actively inflamed or not, whilst radionuclide study with HIG is capable to distinguish actively inflamed joints, even in patients with serum negative RA, in a greater extent than anatomical imaging modalities.
authors: G
authors: G
authors: Gerasimou
authors: E
authors: E
authors: Moralidis
authors: E
authors: E
authors: Papanastasiou
authors: G
authors: G
authors: Liaros
authors: T
authors: T
authors: Aggelopoulou
authors: E
authors: E
authors: Triantafyllidou
authors: N
authors: N
authors: Lytras
authors: L
authors: L
authors: Settas
authors: A
authors: A
authors: Gotzamani-Psarrakou
references: J Rheumatol. 1992 Sep;19(9):1371-6
references: 1433003
references: Eur J Nucl Med. 1991;18(2):119-23
references: 2044570
references: Ann Rheum Dis. 1990 Nov;49(11):916-20
references: 2256738
references: Eur J Nucl Med. 1992;19(3):173-6
references: 1572380
references: J Nucl Med. 1989 Sep;30(9):1538-45
references: 2504892
references: Eur J Nucl Med. 1992;19(10):853-7
references: 1451700
references: J Nucl Biol Med. 1991 Jan-Mar;35(1):14-20
references: 1932171
references: Mol Imaging Biol. 2007 Nov-Dec;9(6):357-60
references: 17902022
references: Eur J Nucl Med. 1990;16(4-6):303-5
references: 2161771
references: Eur J Radiol. 1998 May;27 Suppl 1:S18-24
references: 9652497
references: Nucl Med Commun. 1987 Nov;8(11):895-908
references: 3441326
references: Eur J Nucl Med. 1990;16(8-10):649-55
references: 2116969
references: Bull Schweiz Akad Med Wiss. 1979 Sep;35(4-6):275-81
references: 161178
references: Clin Exp Rheumatol. 1995 Mar-Apr;13(2):155-9
references: 7656461
references: Rheumatol Int. 2001 Feb;20(2):71-7
references: 11269536
references: Semin Nucl Med. 1988 Oct;18(4):335-44
references: 3212469
references: Clin Microbiol Infect. 2005 Jun;11(6):480-5
references: 15882198
references: Nuklearmedizin. 1991 Feb;30(1):18-23
references: 2062673
references: Clin Nucl Med. 2005 Feb;30(2):124-5
references: 15647686
references: J Nucl Med. 2004 Jun;45(6):956-64
references: 15181130
references: Eur J Nucl Med Mol Imaging. 2009 Apr;36(4):624-31
references: 19043704
references: Nucl Med Commun. 1993 Mar;14(3):225-31
references: 8455914
references: Clin Nucl Med. 2003 Apr;28(4):277-85
references: 12642704
references: Acta Med Austriaca. 1998;25(1):7-12
references: 9576018
references: J Rheumatol. 1995 Aug;22(8):1461-5
references: 7473466
references: Lancet. 1989 Oct 21;2(8669):965-7
references: 2571873
references: Ann Nucl Med. 1999 Dec;13(6):389-95
references: 10656272
references: Nucl Med Commun. 1993 Oct;14(10):883-7
references: 8233232
references: Q J Nucl Med Mol Imaging. 2006 Sep;50(3):217-25
references: 16868535
references: J Nucl Med. 1989 Dec;30(12):2017-21
references: 2585104
references: Clin Nucl Med. 2006 Jul;31(7):386-90
references: 16785804
references: Nucl Med Commun. 1996 Jun;17(6):523-8
references: 8822752
references: N Engl J Med. 1989 Oct 5;321(14):935-40
references: 2779615
references: Eur J Nucl Med Mol Imaging. 2010 Feb;37(2):386-98
references: 19777175
references: Br J Rheumatol. 1989 Aug;28(4):287-92
references: 2787183
references: Nucl Med Commun. 1990 Dec;11(12):843-56
references: 2284083