Abdominal scintigraphy using99mTc-HMPAO-labelled leucocytes in patients with seronegative spondylarthropathies without clinical evidence of inflammatory bowel disease

Abstract

Abdominal scintigraphy with technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes is an excellent tool for evaluating disease extent and activity of intestinal lesions in patients with inflammatory bowel disease (IBD). In some cases of seronegative spondylarthropathies (SSp), IBD may remain subclinical. The aim of this study was to evaluate the presence of positive abdominal scintigraphy in patients with SSp and without clinical symptoms or signs of IBD. To this end we studied 32 patients with active SSp (European Spondylarthropathy Study Group 1991 criteria) without clinical evidence of IBD (eight had ankylosing spondylitis, four psoriatic arthritis, three reactive arthritis an 17 undifferentiated SSp) and 11 controls without SSp. All SSp and control patients received similar doses of non-steroidal anti-inflammatory drugs (NSAIDs). Abdominal scintigraphic images were obtained at 30 and 120 min after re-injection of 99mTc-HMPAO-labelled leucocytes. The 99mTc-HMPAO-labelled leucocyte scan was positive in 17 patients with SSp (53.1%) (six with ankylosing spondylitis, three with psoriatic arthritis, two with reactive arthritis and six with undifferentiated SSp). Fourteen patients scored from 2 to 4 on the intensity of uptake scale. The colon and terminal ileum were predominantly involved. Axial involvement was more frequent in patients with a positive scan than in patients with negative results (P<0.05) (64.7% vs 26.6%; odds ratio: 5). No control patient showed a positive scan. It is concluded that 99mTc-HMPAO-labelled leucocyte scan shows increased uptake among patients with SSp without evidence of IBD. These findings provide new evidence linking SSp with intestinal inflammation and suggest that in some cases a bowel-related process could contribute to the development of SSp. Long-term follow-up studies with more patients are necessary to evaluate the diagnostic and therapeutic implications of these results.

Probiotics in arthralgia and spondyloarthropathies in patients with inflammatory bowel disease: Prospective randomized trials are necessary

“…The role of increased intestinal permeability was confirmed by abdominal scintigraphy with technetium-99m hexamethylpropylene amine oxime in SpA patients (22). Colonoscopy showed a statistically significant concordance with abdominal scintigraphy (23).…”

Tc-99m HIG Scintigraphy in Detection of Active Inflammation in Ankylosing Spondylitis

“…That’s why we observed more lesions in late phase of bone scan than the blood pool images and HIG scan. Other scintigraphic methods like Tc-99m HMPAO leukocyte scintigraphy which was used to detect inflammatory bowel disease associated with spondyloartropathies (26) are not indicated in inflammatory joint diseases. Tc-99m pyrophosphate and Tc-99m nanocolloid used in detecting inflammatory processes in AS were shown to be neither sensitive nor specific to diagnose sacroiliitis (27).…”

Technetium‐99m HMPAO‐Labeled Leukocyte Imaging Compared with Endoscopy, Ultrasonography, and Contrast Radiology in Children with Inflammatory Bowel Disease

“…LLS provides information about the extent of the disease, but also about extraintestinal localization, like arthritis (29). LLS was proposed to detect IBD during spondylarthropathies without clinical evidence of IBD in adults (30,31) and in children (32). One contribution is to identify the involvement of the terminal ileum in CD (see Fig.…”