Araştırma Makalesi
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Bone scintigraphy, DAS 28 score and biochemical parameters in patients with Rheumatoid Arthritis

Yıl 2015, Cilt: 12 Sayı: 2, 255 - 260, 30.08.2015

Öz

Background: Rheumatoid arthritis (RA) is a chronic inflammatory and autoimmune disease characterized
by progressive damage of joints. In this study, we investigated the relationship between the disease activity scores and bone scan findings and biochemical parameters in patients with RA.
Method: Sixty two patients (F/M: 44/8, age 51,8±11,1; range 31-77) diagnosed with RA according to the
American College of Rheumatology (ACR) criteria were included in the study. All patients were divided to
two groups regarding their DAS28 score; Group 1 was DAS28 score≥3,2 and Group 1 was DAS28
score<3,2. The whole body bone scintigraphy with Tc99m-MDP (TVKS) was performed all subject. A
increased uptake on any joint in blood pool phase and late static phase of bone scan was evaluated as a
positive result. Laboratory data including the erythrocyte sedimentation rate and C-reactive protein were
recorded. The clinical parameters were assessed by the Health Assessment Questionnaire (HAQ) and Ritchie
articular index (RAİ).
Results: The mean number of peripheral joint involvement was higher in Group 1 than in Group 2 (11/8;
p<0.05). Number of joint involvement (r=0.5,p=0.019) and biochemical parameters (r=0.7,p<0.001) were
increased with clinical score in Higher disease activity score group. In 6 of 13 patients of lower DAS28
group, number of peripheral joint involvement were similar to high DAS28 group.
Conclusion: Whole body bone scintigraphy is a cheap and easy method, that contributes a lot to the clinical
approach in patients with rheumatoid arthritis, in the evaluation of peripheral joints in a single session and
determining the joints those not expressing significant clinical findings yet.

Kaynakça

  • 1- Grassi W, De Angelis R, Lamanna G, Cervini C. The clinical features of rheumatoid arthritis.Eur J Radio. 1998;27(1):18-24 2-Goldring SR. Pathogenesis of bone and cartilage destruction in rheumatoid arthritis. Rheumatol 2003;42 (2):11-6 3-Backhaus M, Kamradt T, Sandrock D, Loreck D, Fritz J, Wolf KJ, Raber H, Hamm B, Burmester GR, Bollow M. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999;42(6):1232–45 4-Van der Linden MP, Knevel R, Huizinga TW, van der Helm-van Mil AH. Classification of rheumatoid arthritis: comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/European League Against R h e u m a t is m c r i t e r i a . A r t h r i t is R h e u m 2011;63(1):37–42 5-Papathanassiou D, Bruna-Muraille C, Jouannaud C, Gagneux-Lemoussu L, Eschard JP, Liehn JC. Singlephoton emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine 2009;76:474–80 6-Holder LE. Radionuclide bone-imaging in the evaluation of bone pain. J Bone Joint Surg Am 1982;64:1391–6 7-Fisher BA, Frank JW, Taylor PC. Do Tc-99mdiphosphonate bone scans have any place in the investigation of polyarthralgia? Rheumatology (Oxford) 2007;46:1036–7 8- Kim JY Cho SK, Han M, Choi YY, Bae SC, Sung YK. The role of bone scintigraphy in the diagnosis of rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria. J Korean Med Sci 2014;29(2):204- 9 9- Van Gestel AM, Haagsma CJ, van Riel PLCM. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum 1998; 41(10):1845–50 10- Fries J, Spitz P, Kraines R, Holman H. Measurement of patient outcome in arthritis. Arthritis and Rheumatism 1980;23(2):137-45 11- Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TG, Grieveson P, Buchanan WW. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 1968;37(147):393-406 12-McQueen FM, Ostergaard M. Established rheumatoid arthritis - new imaging modalities. Best Pract Res Clin Rheumatol. 2007;21(1):841–56 13- Ostergaard M, Gideon P, Sorensen K, Hansen M, Stoltenberg M, Henriksen O, et al. Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist. Scand J Rheumatol 1995;24(1):212–8 14- Duncan I, Dorai-Raj A, Khoo K, Tymms K, Brook A. The utility of bone scans in rheumatology. Clin Nucl Med 1999;24(1):9–14 15-Kim JY, Cho SK, Han M, Choi YY, Bae SC, Sung YK. The role of bone scintigraphy in the diagnosis of rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria. J Korean Med Sci 2014;29(2):204-9 16-Papathanassiou D, Bruna-Muraille C, Jouannaud C, Gagneux-Lemoussu L, Eschard JP, Liehn JC. Singlephoton emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine 2009;76(1):474–80 17-Ezziddin S, Khalaf F, Seidel M, Al Zreiqat A, WilsmannTheis D, Simon B, Biersack HJ, Sabet A. Introduction of a metabolic joint asymmetry score derived from conventional bone scintigraphy. Anew tool to differentiate psoriatic from rheumatoid arthritis. Nuklearmedizin 2015;13;54(4) [Epub ahead of print] 18-Yildirim K, Karatay S, Melikoglu MA, et al. Associations between acute phase reactant levels and disease activity score (DAS28) in patients with rheumatoid arthritis. Ann Clin Lab Sci 2004;34:423-6

Romatoid artrit'te kemik sintigrafisi bulguları, DAS28 skoru ve biyokimyasal parametrelerin karşılaştırılması

Yıl 2015, Cilt: 12 Sayı: 2, 255 - 260, 30.08.2015

Öz

Amaç: Romatoid artrit (RA), eklemlerde ilerleyici hasarla karakterize kronik inflamatuar ve otoimmun bir
hastalıktır. Bu çalışmada RA'lı hastalarda klinik, biyokimyasal ve sintigrafik bulguların karşılaştırılması
amaçlanmıştır.
Materyal ve metod: Çalışmaya American College of Rheumatology (ACR) kriterlerine göre RA tanısı
almış 62 hasta (K/E: 44/8, yaş ortalaması 51,8±11,1; yaş aralığı 31-77) dahil edilmiştir. Tüm hastalar DAS28
(Disease Activity Score) skorlamasına göre hastalar iki gruba ayrıldı; DAS28 skoru ≥3,2 olanlar hastalık
aktivitesi yüksek (Grup 1), <3,2 olanlar hastalık aktivitesi düşük (Grup 2) olarak tanımlandı. Tüm hastalara
Tc99m-MDP ile yapılan kemik sintigrafisi yapıldı. Kan havuzu ve geç statik fazda izlenen artmış aktivite
tutulumları pozitif bulgu olarak değerlendirildi. Ayrıca hastaların serum biyokimyasal enflamatuar
belirteçlerine (CRP, sedimentasyon, RF) bakıldı. Klinik bulgular Health Assessment Questionnaire (HAQ)
ve Ritchie articular index (RAI) ile değerlendirildi.
Bulgular: DAS28 skoru yüksek olan Grup 1'de skoru düşük olan Grup 2'ye göre daha fazla sayıda periferik
eklem tutulumu (11/8 eklem) gözlendi (p<0.05). Hastalık aktivite skoru yüksek olan grupta klinik skor
arttıkça eklem tutulumu sayısı (r=0.5,p=0.019) ve biyokimyasal parametrelerde artış izlendi
(r=0.7,p<0.001). DAS28 skoru düşük bulunan 13 hastanın 6'sında ise kemik sintigrafisinde klinik skoru
yüksek olan gruptakine benzer sayıda periferik eklem tutulumu saptandı.
Sonuç: Romatoid artrit tanılı hastalarda, tüm vücut kemik sintigrafisi, aktif hastalığın bulunduğu periferik
eklemlerin tek seansta değerlendirilmesinde ve henüz belirgin klinik bulgu göstermeyen eklemlerin
tespitinde, klinik yaklaşıma önemli katkıda bulunan, ucuz ve kolay uygulanabilen bir yöntemdir. 

Kaynakça

  • 1- Grassi W, De Angelis R, Lamanna G, Cervini C. The clinical features of rheumatoid arthritis.Eur J Radio. 1998;27(1):18-24 2-Goldring SR. Pathogenesis of bone and cartilage destruction in rheumatoid arthritis. Rheumatol 2003;42 (2):11-6 3-Backhaus M, Kamradt T, Sandrock D, Loreck D, Fritz J, Wolf KJ, Raber H, Hamm B, Burmester GR, Bollow M. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999;42(6):1232–45 4-Van der Linden MP, Knevel R, Huizinga TW, van der Helm-van Mil AH. Classification of rheumatoid arthritis: comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/European League Against R h e u m a t is m c r i t e r i a . A r t h r i t is R h e u m 2011;63(1):37–42 5-Papathanassiou D, Bruna-Muraille C, Jouannaud C, Gagneux-Lemoussu L, Eschard JP, Liehn JC. Singlephoton emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine 2009;76:474–80 6-Holder LE. Radionuclide bone-imaging in the evaluation of bone pain. J Bone Joint Surg Am 1982;64:1391–6 7-Fisher BA, Frank JW, Taylor PC. Do Tc-99mdiphosphonate bone scans have any place in the investigation of polyarthralgia? Rheumatology (Oxford) 2007;46:1036–7 8- Kim JY Cho SK, Han M, Choi YY, Bae SC, Sung YK. The role of bone scintigraphy in the diagnosis of rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria. J Korean Med Sci 2014;29(2):204- 9 9- Van Gestel AM, Haagsma CJ, van Riel PLCM. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum 1998; 41(10):1845–50 10- Fries J, Spitz P, Kraines R, Holman H. Measurement of patient outcome in arthritis. Arthritis and Rheumatism 1980;23(2):137-45 11- Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TG, Grieveson P, Buchanan WW. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 1968;37(147):393-406 12-McQueen FM, Ostergaard M. Established rheumatoid arthritis - new imaging modalities. Best Pract Res Clin Rheumatol. 2007;21(1):841–56 13- Ostergaard M, Gideon P, Sorensen K, Hansen M, Stoltenberg M, Henriksen O, et al. Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist. Scand J Rheumatol 1995;24(1):212–8 14- Duncan I, Dorai-Raj A, Khoo K, Tymms K, Brook A. The utility of bone scans in rheumatology. Clin Nucl Med 1999;24(1):9–14 15-Kim JY, Cho SK, Han M, Choi YY, Bae SC, Sung YK. The role of bone scintigraphy in the diagnosis of rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria. J Korean Med Sci 2014;29(2):204-9 16-Papathanassiou D, Bruna-Muraille C, Jouannaud C, Gagneux-Lemoussu L, Eschard JP, Liehn JC. Singlephoton emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine 2009;76(1):474–80 17-Ezziddin S, Khalaf F, Seidel M, Al Zreiqat A, WilsmannTheis D, Simon B, Biersack HJ, Sabet A. Introduction of a metabolic joint asymmetry score derived from conventional bone scintigraphy. Anew tool to differentiate psoriatic from rheumatoid arthritis. Nuklearmedizin 2015;13;54(4) [Epub ahead of print] 18-Yildirim K, Karatay S, Melikoglu MA, et al. Associations between acute phase reactant levels and disease activity score (DAS28) in patients with rheumatoid arthritis. Ann Clin Lab Sci 2004;34:423-6
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Makalesi
Yazarlar

Seyhan Karaçavuş Bu kişi benim

Mehmet Uçar

Mehmet Fatih Geçer Bu kişi benim

Özlem Balbaloğlu Bu kişi benim

Ömer Nas Bu kişi benim

Ümit Sarp Bu kişi benim

Yayımlanma Tarihi 30 Ağustos 2015
Gönderilme Tarihi 19 Nisan 2015
Kabul Tarihi 26 Nisan 2015
Yayımlandığı Sayı Yıl 2015 Cilt: 12 Sayı: 2

Kaynak Göster

Vancouver Karaçavuş S, Uçar M, Geçer MF, Balbaloğlu Ö, Nas Ö, Sarp Ü. Romatoid artrit’te kemik sintigrafisi bulguları, DAS28 skoru ve biyokimyasal parametrelerin karşılaştırılması. Harran Üniversitesi Tıp Fakültesi Dergisi. 2015;12(2):255-60.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty