Abstract
BackgroundThe purpose of this study was to investigate the efficiency of quantitative parameters of bone scintigraphy in detecting clinically active joint and high disease activity in patients with rheumatoid arthritis.MethodsWe retrospectively enrolled 65 patients with rheumatoid arthritis who underwent bone scintigraphy for diagnostic work-up. Quantitative analysis of bone scintigraphy images was conducted using an in-house software, and joint uptake ratio of 28 joints was measured for the calculation of the disease activity score of 28 joints using erythrocyte sedimentation rate (DAS28-ESR). The relationship between joint uptake ratio and clinical findings and the efficiency of joint uptake ratio in detecting clinically active joint and high disease activity were assessed.ResultsClinically active joint (tender and/or swollen joints) showed significantly higher joint uptake ratio than did other non-affected joints (p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of joint uptake ratio for identifying clinically active joint were 78.7%, 52.0%, 32.9%, and 89.1%, respectively, and those of the summed joint uptake ratio for detecting high disease activity were 92.9%, 66.8%, 43.3%, and 97.1%, respectively; the joint uptake ratio showed high detection ability, especially for active joints of the elbow, wrist, and metacarpo-phalangeal joint areas. The summed joint uptake ratio of 28 joints showed a significantly strong positive correlation with DAS28-ESR (p < 0.001; correlation coefficient, 0.725).ConclusionQuantitative parameters of bone scintigraphy showed high sensitivity and NPV for detecting clinically active joint and high disease activity in patients with rheumatoid arthritis.
Highlights
The purpose of this study was to investigate the efficiency of quantitative parameters of bone scintigraphy in detecting clinically active joint and high disease activity in patients with rheumatoid arthritis
65 patients were included in the present study according to the following inclusion criteria (Fig. 1): (1) diagnosis of rheumatoid arthritis according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis, (2) presence of bone scintigraphy images which were able to be quantitatively analyzed using our in-house software, those containing whole-body anterior and spot images that properly included 14 joint areas [10], and (3) patient age of ≥ 18 years
Among the 1817 joints included for calculating disease activity score of 28 joints (DAS28)-Erythrocyte sedimentation rate (ESR), there were 174 tender joints (9.6%), 44 swollen joints (2.4%), and 200 joints that were both tender and swollen (11.0%); thereby, 418 joints (23.0%) were clinically active joints
Summary
The purpose of this study was to investigate the efficiency of quantitative parameters of bone scintigraphy in detecting clinically active joint and high disease activity in patients with rheumatoid arthritis. The treat-to-target concept has been considered as the principle of treatment strategy for rheumatoid arthritis; it aims to achieve early clinical remission or low disease activity with early intervention and to sustain. To provide prompt and appropriate treatment to patients with rheumatoid arthritis, it is important to accurately estimate the disease activity [4, 5]. In clinical practice, various imaging modalities that can evaluate the presence and degree of joint inflammation have been used to detect synovitis and to estimate the disease activity in patients with rheumatoid arthritis [6, 7]
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