J Korean Med Sci.  2014 Feb;29(2):204-209. 10.3346/jkms.2014.29.2.204.

The Role of Bone Scintigraphy in the Diagnosis of Rheumatoid Arthritis According to the 2010 ACR/EULAR Classification Criteria

• Kim JY
• Cho SK
• Han M
• Choi YY
• Bae SC
• Sung YK

• KMID: 1789976
• DOI: http://doi.org/10.3346/jkms.2014.29.2.204

Abstract

We aimed to investigate the role of bone scintigraphy (BS) in the diagnosis of rheumatoid arthritis (RA) as a supplement to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. A total of 156 patients who underwent BS with screening laboratory to confirm RA were enrolled. We divided them into two groups according to the presence of arthritis upon the first physical examination, and evaluated the diagnostic validity of BS as an independent (BS only) or assistant diagnostic tool using the 2010 criteria (BS-assisted). Seventy-five patients had active arthritis (Group I), while the remaining 81 patients did not (Group II). Among them, 56 patients in group I and 5 patients in group II were finally classified as RA. In the group I patients who were eligible for application of the 2010 criteria, the sensitivity of the BS only and BS-assisted diagnosis was not superior to that of the 2010 criteria. However, BS-assisted diagnosis showed high positive prediction values in group I patients with 2010 criteria score < 6 and group II patients. Therefore, BS is still helpful to detect RA even after the introduction of the 2010 criteria, especially among patients who do not satisfy the 2010 criteria as well as those who are ineligible for the 2010 criteria due to dubitable arthritis at clinical presentation.

Keyword

Arthritis, Rheumatoid; 2010 ACR/EULAR Classification Criteria; Bone Scintigraphy

MeSH Terms

Aged
Area Under Curve
Arthritis, Rheumatoid/classification/*diagnosis/radionuclide imaging
Demography
Female
Humans
Male
Middle Aged
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Technetium/chemistry/diagnostic use
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed
Technetium

Figure

• 

  Fig. 1 Flow chart of the selection of participants in the study. The populations analyzed are indicated in bold.

• 

  Fig. 2 99mTc-HDP bone scintigraphy (BS) finidings considered as Rheumatoid arthritis (RA) in a 41 years old female patient with bilateral hands and feet pain for 4 months. Regional blood pool images (A) show fusiform increased radiotracer uptakes in right 2nd, 3rd, 5th, left 3rd, 5th PIP joints and left 1st IP joint of both hands as well as right 4th and left 2nd, 3rd, 5th MTP joints of both feet. Delayed regional bone images (B) show increased periarticular bone uptakes in identical areas of both hands and both feet. Delayed whole body image (C) demonstrates no other joint involvement in this patient.

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