title: Evaluating disease activity in patients with ankylosing spondylitis and rheumatoid arthritis using 99mtc-glucosamine.
abstract: OBJECTIVE
  To evaluate the clinical utility of a novel radiotracer,99mTc-glucosamine, in assessing disease activity of both rheumatoid arthritis (RA) and ankylosing spondylitis (AS).Material and Methods:Twenty-five patients with RA (nine males and 16 females) and 12 patients with AS (all male) at various stages of disease were recruited for the study. A clinical history and examination was performed, followed by the measurement of hematological, biochemical, and autoimmune serological parameters to assess disease activity.99mTc-glucosamine was intravenously administered and scans were compared with other imaging modalities, including plain X-ray, magnetic resonance imaging (MRI), and bone scans.
  
  
  RESULTS
  In patients with AS,99mTc-glucosamine scans were more capable of identifying active disease and differentiating between inflammatory and non-inflammatory causes. In patients with RA,99mTc-glucosamine accumulated at all known sites of disease involvement. Uptake was most pronounced in patients with active untreated disease. The relative tracer activity in the involved joints increased with time compared with that in the adjoining soft tissue, liver, and cardiac blood pool. Using Spearman's correlation coefficient, there was a positive correlation among glucosamine scan scores, C-reactive protein (p=0.048), and clinical assessment (p=0.003), which was not noted with bone scans.
  
  
  CONCLUSIONS
  The radiotracer was well tolerated by all patients, with no adverse reactions.99mTc-glucosamine imaging could detect spinal inflammation in AS. With respect to RA,99mTc-glucosamine was a viable alternative to99mTc-labeled methylene diphosphonate nuclear bone scans for imaging inflamed joints and had the added advantage of demonstrating a significant clinical correlation between disease activity and scan findings.
authors.affiliation: Department of Rheumatology, Westmead Hospital, Sydney, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Manolios
authors.affiliation: Department of Rheumatology, Westmead Hospital, Sydney, Australia.
authors.forename: Marina
authors.initials: M
authors.lastname: Ali
authors.affiliation: Department of Rheumatology, Westmead Hospital, Sydney, Australia.
authors.forename: Bradley
authors.initials: B
authors.lastname: Camden
authors.affiliation: Department of Rheumatology, Westmead Hospital, Sydney, Australia.
authors.forename: Elham
authors.initials: E
authors.lastname: Aflaky
authors.affiliation: Department of Rheumatology, Westmead Hospital, Sydney, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Pavic
authors.affiliation: Department of Nuclear Medicine, Westmead Hospital, Sydney, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Markewycz
authors.affiliation: Department of Radiology, Westmead Hospital, Sydney, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: De Costa
authors.affiliation: Department of Nuclear Medicine, Westmead Hospital, Sydney, Australia.
authors.forename: Socrates
authors.initials: S
authors.lastname: Angelides
keywords: Glucosamine; ankylosing spondylitis; nuclear scan; rheumatoid arthritis