Abstract
Objective: The diagnosis of active inflammation in ankylosing spondylitis (AS) is crucial for treatment to delay possible persistent deformities. There are no specific laboratory tests and imaging methods to clarify the active disease. We evaluated the value of Tc-99m human immunoglobulin (HIG) scintigraphy in detection of active inflammation. Material and Methods: Twenty-nine patients were included. Tc-99m methylenediphosphonate bone (MDP) and HIG scintigraphies were performed within 2-5 day intervals. Two control groups were constituted both for MDP and HIG scintigraphies. Active inflammation was determined clinically and by serologic tests. Both scintigraphies were evaluated visually. Sacroiliac joint index values (SII) were calculated. Results: Active inflammation was considered in five (sacroiliitis in 2, sacroiliitis-spinal inflammation in 1, achilles tendinitis in 1, arthritis of coxafemoral joints in 1) patients. HIG scintigraphy demonstrated active disease in all 3 patients with active sacroiliitis. But, it was negative in the rest. The other 2 active cases were HIG negative. Right and left SII obtained from HIG scintigraphy was higher (p<0.05) in clinically active patients than inactive patients. There was not any significant difference between patients with inactive sacroiliitis and normal controls. Right and left SII obtained from bone scintigraphy was higher (p<0.05) in patient group than in control group. Conclusion: Clinically inactive AS patients, behave no differently than normal controls with quantitative sacroiliac joint evaluation on HIG scintigraphy. HIG scintigraphy may be valuable for evaluation of sacroiliac joints in patients with uncResults:ertain laboratory and clinical findings.Conflict of interest:None declared.
Highlights
Material and MethodsAnkylosing Spondylitis is the prototype of spondyloarthropathies [1]
erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were both high in 17 patients (59%)
According to general acceptance immunologic mechanisms play a major role in the pathogenesis of peripheric inflammatory arthropathy and sacroiliitis observed in ankylosing spondylitis (AS) patients [3]
Summary
Ankylosing Spondylitis is the prototype of spondyloarthropathies [1]. It is a chronic systemic inflammatory disease that mainly affects the axial skeleton. The typical presentation of the disease is with low back pain of insidious onset. Arthritis of hips and shoulders and enthesopathies are common [2]. The sacroiliac joints are always affected [3]. The etiopathogenesis of AS is not clearly understood, HLA-B27 is likely to play a central role [2]. The skeletal pathology of AS is an inflammatory erosive process, evolving the enthesis, followed by new bone formation
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