Quantitative sacroiliac scintigraphy (QSS) was evaluated for the detection of sacroiliac (SI) joint disease before the appearance of radiographic/changes. QSS with fractional quantitation was done in 13 age- and sex-matched controls and 28 patients with different grades of radiographic sacroiliitis. The SI index of each joint was considered separately. The mean SI index values in patients with grade I radiographic sacroiliitis (1.54) and HLA-B27 positive patients with low back pain (1.50) were significantly (P less than 0.01) higher than the mean SI index of controls (1.22); but more than 50% of their SI index values were within the 97.5% confidence limits of the control range. The mean SI index values of patients with grade II (1.38) and grade III (1.34) radiographic sacroiliitis did not differ significantly from the mean SI index of controls (P greater than 0.05). Thus a large overlap between the normal and abnormal ranges of sacroiliac ratios limits the utility of quantitative sacroiliac scintigraphy for the early diagnosis of sacroiliac joint disease.
Thirty-six patients fulfilling the criteria for Reiter's disease were studied (29 men and 7 women; 4:1). The mean age of onset was 23.8 years; in 75% of patients the onset was in the second and third decades. Clinical manifestations included low back pain and stiffness (69%), non specific urethritis (53%), heel pain (44%), radiographic sacroiliitis (42%), conjunctivitis (39%), dysentery and diarrhoea (33%), mucosal ulcerations (17%) kidney disease (14%), anterior uveitis (19%), and keratoderma blennorrhagicum (8%). Peripheral arthritis was mono or oligoarthritis in 58% of patients, mainly affecting the large joints of lower extremities, and it was often asymmetric (mean degree of asymmetry = 0.37). HLA-B27 antigen was detected in 83% of 36 patients compared with 5.9% of 118 controls (relative risk 79, corrected Fisher's P = 7.719E-18).
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