Samuel Aban M, Jain Hm
Department of Nuclear Medicine, Institute of Functional Imaging and Research, Mumbai, Maharashtra, India.
Indian J Nucl Med. 2012 Apr;27(2):73-80. doi: 10.4103/0972-3919.110679.
The reported prevalence of osteoarthritis (OA) varies according to the method that is used to detect it. X-rays are commonly used in the diagnosis of OA. However, marked osteoarthritic damage must be present to detect characteristic changes with radiologic imaging. Our intention was to evaluate bone scans (1) he occurrence of such changes, (2) he incidence of OA (single or multiple joints) in the general population (a mixture of urban and rural) who were asymptomatic. Data on OA incidence in India is sketchy and sparse as against more detailed information obtained from USA and European nations. Also, clinical rheumatologists are not well-versed with the potential application of bone scans in the management of arthritides.
Two hundred and eighty nine planar images of routine bone scans were randomly evaluated by two trained nuclear medicine physicians. The ages of the patients ranged from 20 to over 80 years.
It is observed that as the age increases, the incidence of joint involvement increases. However, it is worth noting that even in the age group of 20-40 years, as many as 34% of asymptomatic persons have involvement of the joints. In this age group, as the manifestation is probably in the inception stage, there is a tendency for single joint involvement as against multiple joints seen in the older age groups. Another point to note is that the incidence of joint involvement was not affected by weight. In our patient population, gross obesity was not seen. The predominant joints involved are the knees and hips, followed by the shoulders and ankles. Females show a higher incidence than males. Some patients would be having only a single site or multiple site involvement. This observation is important as in a single, simple test whole body survey gives more information with low radiation burden.
Scintigraphic prevalence of OA is higher than reported in US, Europe, and Asia as this test is more sensitive in detecting early changes as compared to radiological changes. These findings on scintigraphy in asymptomatic cases have not been described to the best of our knowledge. Epidemiological demography in published reports is based on clinical or radiological changes observed in single joints which are predominantly symptomatic and multiple joint involvement is rarely recorded. The sensitivity of scintigraphy to show early changes in bone homeostasis and remodeling needs to be exploited.
据报告，骨关节炎（OA）的患病率因检测方法而异。X射线常用于OA的诊断。然而，必须存在明显的骨关节炎损伤才能通过放射影像学检测到特征性变化。我们的目的是评估骨扫描：（1）此类变化的发生率；（2）在无症状的普通人群（城乡混合）中OA（单关节或多关节）的发病率。与从美国和欧洲国家获得的更详细信息相比，印度关于OA发病率的数据粗略且稀少。此外，临床风湿病学家对骨扫描在关节炎管理中的潜在应用并不熟悉。
两名经过培训的核医学医生随机评估了289例常规骨扫描的平面图像。患者年龄在20岁至80多岁之间。
观察到随着年龄的增加，关节受累的发生率增加。然而，值得注意的是，即使在20 - 40岁年龄组中，多达34%的无症状者有关节受累。在这个年龄组中，由于表现可能处于初始阶段，与老年组中多关节受累相比，有单关节受累的倾向。另一个需要注意的点是，关节受累的发生率不受体重影响。在我们的患者群体中，未发现严重肥胖。主要受累关节是膝盖和臀部，其次是肩膀和脚踝。女性的发病率高于男性。一些患者可能只有单个部位或多个部位受累。这一观察结果很重要，因为在一项简单的全身检查中，单次检查就能提供更多信息且辐射负担低。
OA的骨闪烁显像患病率高于美国、欧洲和亚洲的报告，因为与放射学变化相比，该检查在检测早期变化方面更敏感。据我们所知，无症状病例的这些骨闪烁显像结果尚未被描述。已发表报告中的流行病学人口统计学基于在主要有症状的单关节中观察到的临床或放射学变化，很少记录多关节受累情况。骨闪烁显像显示骨内稳态和重塑早期变化的敏感性需要得到利用。
