Central European Journal of Medicine

, Volume 8, Issue 5, pp 558–564 | Cite as

Anti-granulocyte scintigraphy in early rheumatoid arthritis — does it work?

  • Edit Horkay
  • Gyöngyvér Kincse
  • József Varga
  • Lajos Szabados
  • Ildikó Garai
  • János Gaál
Research Article



To compare the performance of anti-granulocyte scintigraphy with those of widely used prognostic indices (such as DAS28, anti-CCP, early MRI imaging).


Twenty-five patients with early arthritis were enrolled into the study. Following the review of clinical data and the evaluation of disease activity, we performed MRI imaging of the hands, anti-granulocyte scintigraphy, and determined anti-CCP positivity. The relationship between the changes of MRI scores and the above prognostic factors were analyzed statistically.


At baseline, values were as follows: DAS28 3.86±1.19, CRI 0.15±0.12, MRI erosions and synovitis scores 25.11±12.82 and 4.32±4.02 (respectively), the ratio of anti-CCP positivity was 7/12 (58%). After the follow-up period of 13.6±2.52 months, erosion and synovitis scores were 43.11±22.23, and 5.32±6.16, respectively (p=0,001 and p=0,015). The occurrence of new erosions was correlated with baseline erosion score (k=0.523, p=0.022) and anti-CCP positivity (p=0.021). The relationship between CRI and baseline synovitis score was strong (=0.518, p=0.023), whereas it was weak only between the former and baseline erosion score (=0.402, p=0.08).


As shown by this study, potential markers for predicting subsequent destructiveness in early RA include MRI and anti-CCP testing, primarily. 99mTc labeled anti-granulocyte joint scintigraphy is appropriate for the objective and quantitative appraisal of disease activity.


Prediction of erosiveness Leukocyte accumulation MRI Anti-granulocyte scintigraphy Anti-CCP positivity 


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  1. [1]
    Kellgren J.H., O’Brien W.M. On the natural history of rheumatoid arthritis in relation to the sheep cell agglutination test (SCAT), Arthritis. Rheum., 1962, 5, 115Google Scholar
  2. [2]
    Withrington R.H., Teitsson I., Valdimarsson H., Seifert M.H. Prospective study of early rheumatoid arthritis. II. Association of rheumatoid factor isotypes with fluctuations in disease activity, Ann. Rheum. Dis., 1984, 43(5), 679–685PubMedCrossRefGoogle Scholar
  3. [3]
    Sharp J.T., Calkins E., Cohen A.S., Schubart A.F., Calabro J.J. Observations on the clinical, chemical, and serological manifestations of rheumatoid arthritis, based on the course of 154 cases, Medicine (Baltimore), 1964, 43, 41–58Google Scholar
  4. [4]
    Geborek P., Saxne T., Pettersson H., Wollheim F.A. Syno.vial fluid acidosis correlates with radiological joint destruction in rheumatoid arthritis knee joints, J. Rheumatol., 1989, 16(4), 468–472PubMedGoogle Scholar
  5. [5]
    Tseng S., Reddi A.H., Di Cesare P.E. Cartilage Oligomeric Matrix Protein (COMP): A Biomarker of Arthritis, Biomark. Insights. 2009, 17(4), 33–44Google Scholar
  6. [6]
    Fujikawa K., Kawakami A., Tamai M., Uetani M., Takao S., Arima K., et al., High serum cartilage oligomeric matrix protein determines the subset of patients with early-stage rheumatoid arthritis with high serum C-reactive protein, matrix metalloproteinase-3, and MRI-proven bone erosion, J. Rheumatol., 2009, 36(6), 1126–1129PubMedCrossRefGoogle Scholar
  7. [7]
    Syversen S.W., Goll G.L., van der Heijde D., Landewé R., Gaarder P.I., Odegård S., et al., Cartilage and bone biomarkers in rheumatoid arthritis: prediction of 10-year radiographic progression, J. Rheumatol. 2009, 36(2), 266–272PubMedCrossRefGoogle Scholar
  8. [8]
    Rousseau J.C., Sumer E.U., Hein G., Sondergaard B.C., Madsen S.H., Pedersen C., et al., Patients with rheumatoid arthritis have an altered circulatory aggrecan profile, BMC Musculoskelet. Disord., 2008, 28,9:74CrossRefGoogle Scholar
  9. [9]
    Syversen S.W., Goll G.L., van der Heijde D., Landewé R., Lie B.A., Odegard, S., et al., Prediction of radiographic progression in rheumatoid arthritis and the role of antibodies against mutated citrullinated vimentin: results from a ten-year prospective study, Ann. Rheum. Dis., 2010. 69(2), 345–351PubMedCrossRefGoogle Scholar
  10. [10]
    Firestein G.S., Etiology and pathogenesis of rheumatoid arthritis, In: Kelly’s Texbook of Rherumatology (Harris E.D.Jr, Budd R.C., Genovese M.C., Firestein G.S., Sargent J.S., Sledge B.C. eds) 7th ed. Oxford 2004, 996–1042Google Scholar
  11. [11]
    Gaál J., Mézes A., Síró B., Varga J., Galuska L., Jánoky G., et al., Tc99m HMPAO labeled leukocyte scintigraphy in patients with rheumatoid arthritis: a comparison with disease activity, Nucl. Med. Commun., 2002, 23:39–46PubMedCrossRefGoogle Scholar
  12. [12]
    Arnett F.C., Edworthy S.M., Bloch D.A., McShane D.J., Fries J.F., Cooper N.S., et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis, Arthritis. Rheum., 1988, 31,:315–324PubMedCrossRefGoogle Scholar
  13. [13]
    Klarlund M., Ostergaard M., Jensen K.E., Madsen J.L., Skjødt H., Lorenzen I., et al., Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group, Ann. Rheum. Dis. 2000, 59(7), 521–528CrossRefGoogle Scholar
  14. [14]
    Fransen J., van Riel P.L., The Disease Activity Score and the EULAR response criteria, Rheum. Dis. Clin. North. Am., 2009, 35(4), 745–757PubMedCrossRefGoogle Scholar
  15. [15]
    Hetland M.L., Ejbjerg B., Hørslev-Petersen K., Jacobsen S., Vestergaard A., Jurik A.G., et al. CIMESTRA study group., MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2-year randomised controlled trial (CIMESTRA), Ann. Rheum. Dis., 2009, 68(3), 384–390PubMedCrossRefGoogle Scholar
  16. [16]
    Palosaari K., Vuotila J., Takalo R., Jartti A., Niemelä R.K., Karjalainen A., et al. Bone oedema predicts erosive progression on wrist MRI in early RA-a 2-yr observational MRI and NC scintigraphy study, Rheumatology, 2006, 45(12), 1542–1548PubMedCrossRefGoogle Scholar
  17. [17]
    Ostendorf B., Schneider M., [Imaging beyond conventional radiography: mini arthroscopy, duplex ultrasonography and positron emission tomography] Z. Rheumatol., 2003, 62(Suppl 2), II 37–40Google Scholar
  18. [18]
    van der Laken C.J., Elzinga E.H., Kropholler M.A., Molthoff C.F., van der Heijden J.W., Maruyama K., et al., Noninvasive imaging of macrophages in rheumatoid synovitis using 11C-(R)-PK11195 and positron emission tomography, Arthritis. Rheum., 2008, 58(11), 3350–3355PubMedCrossRefGoogle Scholar
  19. [19]
    Möttönen T.T., Hannonen P., Toivanan J., Rekonen A., Oka M. M., Value of joint scintigraphy in the prediction of erosiveness in early rheumatoid arthritis, Ann. Rheum. Dis., 1988, 47, 183–189PubMedCrossRefGoogle Scholar
  20. [20]
    de Bois M.H., Westedt M.L., Arndt J.W., Wiarda K.S., van der Velde E.A., Pauwels EK., et al., Value of 99mTc-IgG scintigraphy in the prediction of joint destruction in patients with rheumatoid arthritis of recent onset, Rheumatol. Int., 1995, 15(4), 155–158PubMedCrossRefGoogle Scholar
  21. [21]
    Takalo R., Niemelä R., Karjalainen A., Leisti E.L., Kautiainen H., Hakala M., (99m)Technetium nanocolloid scintigraphy in prognostication of early RA Scand. J. Rheumatol. 2011, 40(2), 152–153Google Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Edit Horkay
    • 1
  • Gyöngyvér Kincse
    • 2
  • József Varga
    • 3
  • Lajos Szabados
    • 4
  • Ildikó Garai
    • 4
  • János Gaál
    • 2
  1. 1.Department of RadiologyUniversity of Debrecen, Medical & Health Sciences CentreDebrecenHungary
  2. 2.Department of Rheumatology’Kenézy Gyula’ HospitalDebrecenHungary
  3. 3.Department of Nuclear MedicineUniversity of Debrecen, Medical & Health Sciences CentreDebrecenHungary
  4. 4.Medical & Health Sciences Centre, PET-CT Medical Diagnostics Ltd.University of DebrecenDebrecenHungary

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