ABSTRACT
Background: Salivary gland scintigraphy allows a non invasive, morphological and functional assessment of parotid and submaxillary salivary glands. Aim: To describe the main features of salivary gland scintigraphy in patients with Sjögren syndrome, rheumatic fibromyalgia and normal controls and compare the results with lip biopsy. Patients and methods: Sixty one normal controls, 66 patients with Sjögren syndrome and 18 patients with rheumatic fibromyalgia were studied. For the diagnosis of Sjögren syndrome and fibromyalgia rheumatica, the Modified European and American College of Rheumatology criteria were used, respectively. Lip biopsies were obtained in 52 patients with Sjögren syndrome. Scintigraphy was done with a gamma camera and computer after the administration of 99mTc-pertechnetate, obtaining images during 30 min and creating time/activity curves. Scintigraphy was classified as normal, with mild or severe alterations. Results: Scintigraphy was normal in 74 percent of control subjects and in 26 percent, it had mild alterations. In 72 percent of patients with rheumatic fibromyalgia, scintigraphy was normal whereas in 28 percent, it had mild alterations. In 27 percent of patients with Sjögren syndrome, scintigraphy was normal, in 27 percent it had mild alterations and in 46 percent, severe alterations. There was a positive and significant correlation between pathological alterations of salivary glands and scintigraphic alterations (r=0.642, p < 0.001). Conclusions: Severe scintigraphic alterations of salivary glands strongly support the diagnosis of Sjögren syndrome. Mild alterations are non specific and anormal scintigraphy does not exclude the diagnosis
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Fibromyalgia , Salivary Glands , Sjogren's Syndrome , Biopsy , Fibromyalgia/diagnosis , Predictive Value of Tests , Sensitivity and Specificity , Lip/pathology , Sjogren's Syndrome/classification , Sjogren's Syndrome/diagnosisABSTRACT
Tubulo interstitial nephritis, the main manifestation of renal involvement in Sjögren syndrome, may lead to a tubular dysfunction that is usually subclinical. We report 3 women, aged 32, 35 and 35 years old, with a primary Sjögren's syndrome and symptomatic type I or distal tubular acidosis. Two patients had nephrolithiasis and one a nephrocalcinosis. Two had a basal hyperchloremic metabolic acidosis. The ammonium chloride acidification test was abnormal in all, demonstrating a distal tubular defect. None had proximal tubular dysfunction. All had an urinary pH over 6.5 and hypocitraturia and none had hypercalciuria. Renal calculi were composed of calcium oxalate and calcium phosphate in 2 patients and calcium phosphate and ammonium phosphate in the other. All women had positive antinuclear antibodies with mottled pattern, 2 had anti Ro antibodies and positive rheumatoid factor and 1 had hypergammaglobulinemia. None had anti La antibodies, crioglobulinemia or monoclonal proteins
Subject(s)
Humans , Female , Adult , Acidosis, Renal Tubular/complications , Nephrocalcinosis/complications , Kidney Calculi/complications , Sjogren's Syndrome/diagnosis , Rheumatoid Factor/isolation & purification , Antibodies, Antinuclear/isolation & purification , Ammonium Chloride , Biomarkers/analysisABSTRACT
We report 25 patients (20 female) aged 34 to 74 years old, with monoarticular synovial chondromatosis. Affected joints were tha knee in 25 cases, the ankle in one case and the elbow in one case. Chronic articular pain was the main symptom, followed by swelling, limitation in motion range, free palpable bodies and symptomatic popliteal cysts. X ray examination showed free calcified osteochondroid bodies in 48 percent of patients and secondary osteoarthritis in 36 percent. Bone scintiscan showed an increased focal uptake. All pathological samples had chondroid or osteochondroid nodules; 64 percent had small blood vessels, thickened with concentric collagen laminae and 20 percent had isolated chondrocytes. Malignant degeneration was not observed. Surgical or artroscopic synevectomy was the procedure of choice in 20 knees. In the affected elbow and ankle, extraction of free bodies was the sole procedure. No recurrences were observed. It is concluded that synovial chondromatosis must be considered in the differential diagnosis of chronic articular pain and monoartritis
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Chondromatosis, Synovial/diagnosis , Osteoarthritis/diagnosis , Arthralgia/diagnosis , Chronic Disease , Popliteal Cyst/diagnosisABSTRACT
Despite the progress in the treatment of rheumatoid arthritis (RA), many patients continue to suffer from persistent and painful synovitis. We assessed the clinical results of 64 intraarticular injections of Yttrium 90 in the knee and 56 injections of Rhenium 186 in the wrist in 71 patients with RA, older than 40 years, without relief of synovitis after six months of systemic or local treatment and with a radiological stage I or II of the joints. We obtained good results in 75 percent of knees and 100 of wrists during a follow up period of 8 to 60 months. A repeat histological examination of the synovial membrane of 14 joints in which good results were obtained disclosed a reduction in inflammation and transitory synovial cell hyperplasia that ended in a dense fibrosis. It is concluded that radiation synovectomy continues to be an effective therapy for selected patients with RA and synovitis. The observed histopathological changes may aid the interpretation of magnetic resonance imaging of the treated joints
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Arthritis, Rheumatoid/radiotherapy , Synovial Membrane/radiation effects , Yttrium Radioisotopes/administration & dosage , Synovial Membrane/pathology , Follow-Up Studies , Wrist Joint/radiation effects , Knee Joint/radiation effects , Radioisotopes/therapeutic use , Magnetic Resonance SpectroscopyABSTRACT
We report two cases of regional migratory osteoporosis. One is a 41 years old male, with the classical form, presenting with succesive episodes of painful osteoporosis lasting for 5 months at the hip, knee and distal epiphysis of the right metatarsophalangeal joints. The second case is a 40 years old female presenting with an unusual disseminated form, lasting for 30 months, with succesive and simultaneous episodes of polyarticular and costal painful osteoporosis. An increased bone fraction of serum alkaline phosphatases and urine hydroxyproline/creatinine and calcium/creatinine ratios were detected. Imaging showed localized periarticular or costal oateoporosis. Bone biopsies disclosed a severe osteopenia with accelerated bone reabsorption. Bone scintigraphy precociously detected location, migration and evolution of lesions. Patients were treated with subcutaneous calcitonin, 100 U/day during 1 month and on alternative days posteriorly; this treatment alleviated pain but did not prevent the appearence of new crisis. Our observations suggest that regional migratory osteoporosis presentation may range from oligoarticular to disseminated forms and that calcitonin has a precocious and persistent analgesic effect