ABSTRACT
The aim of this study was to describe the use of (99m)Tc-anti-TNF-α scintigraphy for detecting inflammation of the sacroiliac joints in a patient with non-radiographic axial spondyloarthritis. A 47-year-old female patient, non-smoker and non-drinker, complained of a low back pain inflammation, which began 4 years before her condition have exacerbated to morning stiffness and anterior uveitis in the last 6 months. Initially diagnosed as mechanical low back pain, she irregularly took non-steroidal anti-inflammatory drugs and corticosteroids, without significant long-lasting results. Radiographic findings were negative. There was increased uptake of (99m)Tc-anti-TNF-α in an area corresponding to the topography of ileum and sacroiliac right joint upon (99m)Tc-anti-TNF-α scintigraphy. Magnetic resonance imaging (MRI), the most used image diagnosis tool, showed minimum impregnation of gadolinium in the right sacroiliac joint and at the iliac face of the inferior third of the right sacroiliac joint. We suggest that (99m)Tc-anti-TNF-α can facilitate early diagnosis of patients with non-radiographic axial spondyloarthritis. More studies are now ongoing.
Subject(s)
Antibodies, Monoclonal, Humanized , Organotechnetium Compounds , Radiopharmaceuticals , Spondylarthritis/diagnostic imaging , Tomography, Emission-Computed, Single-Photon/methods , Tumor Necrosis Factor-alpha/immunology , Adalimumab , Contrast Media , Diagnosis, Differential , Female , Gadolinium , Humans , Magnetic Resonance Imaging , Middle Aged , Radiography , Sacroiliac Joint/diagnostic imaging , Spondylarthritis/diagnosisABSTRACT
OBJECTIVE: To compare the use of radiolabelled human monoclonal anti-TNF-α scintigraphy with clinical examination and MRI of hands and wrists joints in patients with active RA. METHODS: Eight patients with active RA, 28-joint DAS (DAS-28) ≥ 3.2 and a healthy volunteer underwent whole body and hand/wrist scintigraphy after the administration of anti-human TNF-α labelled with technetium-99m ((99m)Tc). One hundred and ninety-eight joints were examined. Patients were also given clinical examinations in addition to MRI of the hands and wrists. RESULTS: Of the 198 joints examined, signs of inflammation were detected by MRI in 49 (24.7%) and by scintigraphy in 48 (24.2%) joints, with agreement between the two methods in 44 joints. In five joints, MRI was positive and scintigraphy negative. In another four joints, scintigraphy was positive and MRI negative for signs of inflammation. MRI and scintigraphy were in agreement for negative results for 145 joints. The sensitivity and specificity of scintigraphy was 89.8 and 97.3%, respectively. When clinical parameters (presence of swelling and tenderness of joints) were compared with the MRI findings, lower correlation coefficients were observed (sensitivity of 59.2% and 65.3%, respectively). CONCLUSIONS: Scintigraphy using (99m)Tc-anti-TNF-α showed high correlation with the presence of inflammatory signs detected by MRI in the hands and wrists of patients with active RA, and demonstrated a greater sensitivity than clinical examination. These results can assist in better understanding of anti-cytokine therapy and support the achievement of evidence-based biologic therapy.
Subject(s)
Antibodies, Monoclonal , Arthritis, Rheumatoid/diagnostic imaging , Magnetic Resonance Imaging/methods , Technetium , Tumor Necrosis Factor-alpha/analysis , Wrist Joint/diagnostic imaging , Adult , Aged , Arthritis, Rheumatoid/pathology , Arthritis, Rheumatoid/physiopathology , Health Status , Humans , Middle Aged , Pilot Projects , Predictive Value of Tests , Radionuclide Imaging , Recovery of Function , Reproducibility of Results , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Tumor Necrosis Factor-alpha/immunologyABSTRACT
Os autores apresentam um caso de artrite reumatóide (AR) clássica de ñ 15 anos de duraçäo que apresentou na evoluçäo vasculite leucocitoclásica. Fazem uma revisäo de literatura e discutem os mecanismos etiopatogênicos envolvidos
