Gerasimou G, Moralidis E, Papanastasiou E, Liaros G, Aggelopoulou T, Triantafyllidou E, Lytras N, Settas L, Gotzamani-Psarrakou A
Hippokratia. 2011 Jan;15(1):37-42.
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.
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.
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.
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.
类风湿关节炎（RA）是一种慢性多关节炎综合征，其中部分关节处于炎症活动期，而其他关节则处于缓解期。骨扫描（BS）可显示因退行性改变导致活动增加的关节，而用人多克隆免疫球蛋白（HIG）进行扫描则能够显示哪些关节存在滑膜的活动性炎症。本研究的目的是探讨HIG分子成像在类风湿关节炎患者中的应用价值。
40例患者（9例男性加31例女性），患有疼痛性多关节炎综合征，平均年龄45.3±7岁，病程18.3±4.2个月，纳入本研究。其中26例患者类风湿因子血清学阳性，被认为患有RA，而另外14例患者类风湿因子血清学阴性，被认为患有血清阴性多关节炎。所有患者均接受了感兴趣关节的X线和超声检查（US），以及用（99m）Tc-MDP进行的全身骨扫描，最后用（99m）Tc-HIG进行扫描。
共评估了1680个关节。在6例患者中——2例血清阴性RA患者（252个关节），尽管在骨扫描中提到30个关节有退行性改变，但用HIG进行的放射性核素成像结果在正常范围内。在所有这些患者中，疾病被评估为非活动期（“关节病变”）。在其余34例患者中——12例血清阴性RA患者（1428个关节），对于血清学阳性患者，有163个关节出现HIG摄取增加（“关节炎改变”），而在同一组中，骨扫描显示265个关节有退行性改变。对于血清阴性患者，相应结果分别为64个关节和190个关节。在189/226个肿胀疼痛的关节中发现HIG摄取增加（根据临床标准总体敏感性为83.3%），在38个无任何炎症临床证据的关节中也发现HIG摄取增加，随访后其中35个关节出现临床活动性炎症，因此特异性为92%。在227个HIG扫描异常的关节中，有185个关节两种方法的检查结果相符。67个关节有异常的X线和超声检查结果。
根据上述情况，RA患者的骨扫描可显示关节是否处于炎症活动期，而用HIG进行的放射性核素研究能够区分活动性炎症关节，即使是血清阴性RA患者，其区分能力在很大程度上优于解剖成像方式。
