Clinical manifestation of Tenosynovitis Pattern on Two-phase Bone Scintigraphy in Suspected Rheumatoid Arthritis

Abstract

Purpose: To investigate the correlation between tenosynovitis pattern on two-phase bone scintigraphy (2P-BS) and clinical manifestation in patients with suspected rheumatoid arthritis (RA).

Materials and Method: 2P-BS including technetium 99m-methyl diphosphonate (99mTc-MDP) blood pool and bone phase imaging in 402 consecutive patients (19-81 years old; mean 48.3 years old) with clinically suspected RA were retrospectively reviewed. According to 2010 RA Classification Criteria, patients were grouped as RA and non-RA. Visual assessment of all fingers, toes, wrists, and ankles on 2P-BS was performed: linear increased activity on the blood pool image with/without focal bone uptake was interpreted as tenosynovitis. Clinical suspected tenosynovitis was evaluated on physical examination. Laboratory data including rheumatoid factor (RF), anti-cyclic citrullinated protein antibody (ACPA), C-reactive protein (CRP), and estimated sedimentation rate (ESR) were obtained. Radiographic findings were also used to define early and established arthritis.

Results: Tenosynovitis pattern was detected in 51 on 2P-BS of 402 patients (12.7%). Of the 51 patients, 48 patients (94.1%) were diagnosed as RA vs. 3 patients (5.9%) as non-RA. Of the 48 RA patients with positive 2P-BS finding, 41 patients (85.4%) had early arthritis and 7 patients (14.6%) had established arthritis. On physical examination, tenosynovitis was suspected in 88 of 402 patients (21.9%). 56.8% belonged to RA group (50/88) and 43.2% to non-RA group (38/88). The tenosynovitis pattern of 2P-BS and physical examination for 402 patients showed statistical difference and moderate agreement. The positive tenosynovitis pattern on 2P-BS represented up to 26.408 of Odds ratio that was highest among those of the RA-associated factors.

Conclusion: Tenosynovitis pattern either on 2P-BS or physical examination was more commonly detected in RA group, compared to non-RA group. Tenosynovitis pattern was more frequently associated with RA especially early arthritis pattern than established arthritis. 2P-BS could give additional information for the prediction of the disease progression in the preclinical or early stage of RA.