Value of joint scintigraphy in the prediction of erosiveness in early rheumatoid arthritis.

Abstract

SUMMARY The value of scintigraphy in predicting development of new erosions in small peripheral joints was studied by visual evaluation of scintigrams and by three computerised methods. In 13 patients with newly diagnosed rheumatoid arthritis a total of 387 joints were examined clinically, scintigraphically, and radiographically. The follow up period was 24 months. Four eroded joints in three patients were found at the onset. Of the joints which were to become eroded, 46/47 were scintigraphically active at all the check ups. Erosions were detected earlier in foot joints than in finger joints. New erosions were especially prone to appear in joints with persisting and high scintigraphic activity. On the contrary, inactive joints by repeated scanning never eroded. Scintigraphic and clinical activity and radiographic erosiveness correlated significantly with each other. The sensitivity and specificity of visual scintigraphic assessment and the relative pixel activity method proved to be superior to the region of interest methods and clinical evaluation for prediction of erosiveness.

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“…Finding solutions to these problems will require the investigation and development of other modalities that will provide a more accurate evaluation of the actual pathologic change(s) involved. For example, bone scintigraphy will demonstrate active joints and will predict which joints will become eroded and which ones will not (20). As magnetic resonance imaging (MRI) continues to develop, our expertise and interpretation of MRI will also improve.…”

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“…Having evaluated the extent of bone-marrow edema with MRI of the hand, wrist, and feet in a 2-year study, Hetland et al considered this index Möttönen et al demonstrated a correlation between high scintigraphic activity and subsequent erosiveness. Their findings also suggested that erosions do not evolve in scintigraphically inactive joints [19].…”

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“…New erosions were especially prone to appear in joints with persisting and high scintigraphic activity. On the other hand, repeatedly scanned but inactive joints never eroded [17].…”