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

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.

Chiropractic Care in the Management of Inactive Ankylosing Spondylitis: A Case Series

“…6 Skeletal scintigraphy (bone scan) has also been found to be sensitive in detecting active disease in the SI joints, although unhelpful in the diagnosis of inactive AS. 7 Magnetic resonance imaging has accuracy in diagnosing early-stage AS inflammatory lesions in the spine and SI joints using fluid-sensitive sequences with fat saturation and contrast enhancement. 6,8 Hoffstetter et al found that lesions revealed on MRI were most likely to occur in the SI joints and spine (62%) and least likely to occur in the spine alone (10%).…”

“…Diagnostic ultrasound (US), magnetic resonance imaging (MRI), bone scintigraphy, and dual-energy x-ray absorptiometry may be used to aid in the diagnosis or gauge treatment effectiveness. [4][5][6][7][8][9][10][11][12] Biomarkers are utilized in the workup of AS. Human leukocyte antigen B27 (HLA-B27) (90%-95%) and endoplasmic reticulum aminopeptidase 2 (ERAP2) are a few genetic markers.…”

The Role of Imaging in Diagnosing Axial Spondyloarthritis

“…Few pilot studies reported the use of immunoscintigraphy with radiolabeled human immunoglobulin or anti-TNF-α in the detection of active sacroiliitis in patients with axSpA. Their results suggest that immunoscintigraphy may have value in the diagnosis of active sacroiliitis ( 90 – 92 ). Lacking confirmation in longitudinal studies, scintigraphy with radiolabeled anti-TNF-α may display good correlation with MRI findings and biological treatment response ( 92 ).…”

The Effect of Intraarticular Triamcinolone Acetonide for Inflammation in Knee Osteoarthritis by Tc-99m HIG Scintigraphy

“…Polyclonal human immunoglobulin (HIG) scintigraphy has been proposed as a reliable and objective imaging method for joint inflammation [16,17]. The mechanism of HIG accumulation in the site of inflammation is not clear [18,19]. The following hypotheses have been proposed for the mechanism: increased vascular permeability [20], specific capture of IgG by receptors for immunoglobulins in inflammatory cells [21], binding to extracellular matrix proteins [22] and bacterial affinity [23].…”