Abstract
There are no specific diagnostic tests or a gold standard method for measuring disease activity and outcome in spondyloarthropathies (SpA). Many different methods have been developed to assess the signs and symptoms in SpA. The aim of this study was to evaluate the value of scintigraphy, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Bath Ankilosing Spondylitis Disease Activity Index (BASDAI) in the evaluation of disease activity in early axial SpA diagnosed with magnetic resonance imaging (MRI). Thirty early MRI-positive axial SpA patients (23 males, 7 females) with a median age of 35 (18–55) years and a median duration of inflammatory low back pain of 24 (8–60) months were included in the study. In the patients with sacroiliitis, the sensitivity, specificity, and positive and negative predictive values of disease activity parameters were determined regarding MRI as the gold standard method. The sensitivities of quantitative scintigraphy, visual scintigraphy, ESR, CRP, and BASDAI were 32, 82, 35, 71, and 60%, respectively. The specificities of quantitative scintigraphy, ESR, CRP, and BASDAI were 100, 100, 50, and 100%, respectively. The positive predictive values of quantitative scintigraphy, visual scintigraphy, ESR, CRP, and BASDAI were 100, 92, 100, 95, and 100%, respectively. The negative predictive values of quantitative scintigraphy, ESR, CRP, and BASDAI were 9, 10, 11, and 15%, respectively. Regarding MRI as the gold standard in the evaluation of disease activity, combined visual and quantitative bone scintigraphy can be valuable in patients with MRI-incompatible implants. Additionally, use of cheaper, simple, and readily reproducible tests such as CRP and BASDAI together could be valuable and practical in detecting disease activity in long-term follow-up of these patients.
Similar content being viewed by others
References
Kataria RK, Brent LH (2004) Spondyloarthropathies. Am Fam Physician 15:2853–2860
Braun J, Sieper J, Bollow M (2000) Imaging of sacroiliitis. Clin Rheumatol 19:51–57
Rudwaleit M, van der Heijde D, Khan MA et al (2004) How to diagnose axial spondyloarthritis early. Ann Rheum Dis 63:535–543
Bollow M, Hermann K-GA, Biedermann T (2005) Very early spondyloarthritis: where the inflammation in the sacroiliac joints starts. Ann Rheum Dis 64:1644–1646
Spoorenberg A, van Tubergen A, Landewe R et al (2005) Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology (Oxford) 44:789–795
Braun J, van der Heijde D (2002) Imaging and scoring in ankylosing spondylitis. Best Pract Res Clin Rheumatol 16:573–604
Baraliakos X, Braun J (2006) Magnetic resonance imaging in spondyloarthropathies. Joint Bone Spine 73:1–3
Weber U, Pfirrmann CW, Kissling RO et al (2007) Whole body MR imaging in ankylosing spondylitis: a descriptive pilot study in patients with suspected early and active confirmed ankylosing spondylitis. BMC Musculoskelet Disord 278:20
O’Shea F, Salonen D, Inman R (2007) The challenge of early diagnosis in ankylosing spondylitis. J Rheumatol 34:5–7
Collantes E, Veroz R, Escudero A et al (2000) Can some cases of ‘possible’ spondyloarthropathy be classified as ‘definite’ or ‘undifferentiated’ spondyloarthropathy? Value of criteria for spondyloarthropathies. Spanish Spondyloarthropathy Study Group. Joint Bone Spine 67:516–520
Battafarano DF, West SG, Rak KM et al (1993) Comparison of bone scan, computed tomography, and magnetic resonance imaging in the diagnosis of active sacroiliitis. Semin Arthritis Rheum 23:161–176
Blum U, Buitrago-Tellez C, Mundinger A et al (1996) Magnetic resonance imaging (MRI) for detection of active sacroiliitis—a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol 23:2107–2115
Puhakka KB, Jurik AG, Egund N et al (2003) Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 44:218–229
Puhakka KB, Melsen F, Jurik AG et al (2004) MR imaging of the normal sacroiliac joint with correlation to histology. Skeletal Radiol 33:15–28
Munoz-Villanueva MC, Munoz-Gomariz E, Escudero-Contreras A et al (2003) Biological and clinical markers of disease activity in ankylosing spondylitis. J Rheumatol 30:2729–2732
Zochling J, Baraliakos X, Hermann KG et al (2007) Magnetic resonance imaging in ankylosing spondylitis. Curr Opin Rheumatol 19:346–352
Braun J, Bollow M, Eggens U et al (1994) Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum 37:1039–1045
Kacar G, Kacar C, Karayalcin B et al (1998) Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis. Ann Nucl Med 12:169–173
Miron SD, Khan MA, Wiesen EJ et al (1983) The value of quantitative sacroiliac scintigraphy in detection of sacroiliitis. Clin Rheumatol 2:407–414
Inanc N, Atagunduz P, Sen F et al (2005) The investigation of sacroiliitis with different imaging techniques in spondyloarthropathies. Rheumatol Int 25:591–594
Yildiz A, Gungor F, Tuncer T et al (2001) The evaluation of sacroiliitis using 99mTc-nanoclloid and 99mTc-MDP scintigraphy. Nucl Med Commun 22:785–794
Lin WY, Wang SJ (1998) Influence of age and gender on quantitative sacroiliac joint scintigraphy. J Nucl Med 39:1269–1272
Dodig D, Domljan Z, Popovic S et al (1988) Effect of imaging time on the values of the sacroiliac index. Eur J Nucl Med 14:504–506
Lin WY, Wang SJ (1996) The influence of two bone agents (99Tcm-pyrophosphate and 99Tcm-methylenediphosphonate) on quantitative sacroiliac joint scintigraphy. Nucl Med Commun 17:1035–1038
Davis MC, Turner DA, Charters JR et al (1984) Quantitative sacroiliac scintigraphy. The effect of method of selection of region of interest. Clin Nucl Med 9:334–340
Kerr HE, Sturrock RD (1999) Clinical aspects, outcome assessment, disease course, and extra-articular features of spondyloarthropathies. Curr Opin Rheumatol 11:235–237
Ozgocmen S, Godekmerdan A, Ozkurt-Zengin F (2007) Acute-phase response, clinical measures and disease activity in ankylosing spondylitis. Joint Bone Spine 74:249–253
Spoorenberg A, van der Heijde D, de Klerk E et al (1999) Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 26:980–984
Dougados M, Gueguen A, Nakache JP et al (1999) Clinical relevance of C-reactive protein in axial involvement of ankylosing spondylitis. J Rheumatol 26:971–974
Yildirim K, Erdal A, Karatay S et al (2004) Relationship between some acute phase reactants and the Bath Ankylosing Spondylitis Disease Activity Index in patients with ankylosing spondylitis. South Med J 97:350–353
Jee WH, McCauley TR, Lee SH et al (2004) Sacroiliitis in patients with ankylosing spondylitis: association of MR findings with disease activity. Magn Reson Imaging 22:245–250
Bredella MA, Steinbach LS, Morgan S et al (2006) MRI of the sacroiliac joints in patients with moderate to severe ankylosing spondylitis. AJR Am J Roentgenol 187:1420–1426
Garrett S, Jenkinson T, Kennedy LG et al (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291
Akkoc Y, Karatepe AG, Akat S et al (2005) A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int 25:280–284
Heuft-Dorenbosch L, van Tubergen A, Spoorenberg A et al (2004) The influence of peripheral arthritis on disease activity in ankylosing spondylitis patients as measured with the Bath Ankylosing Spondylitis Disease Activity Index. Arthritis Rheum 51:154–159
Puhakka KB, Jurik AG, Schiottz-Christensen B et al (2004) Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings. Rheumatology (Oxford) 43:234–237
Khan MA (2002) Update on spondyloarthropathies. Ann Intern Med 136:896–907
Williamson L, Dockerty JL, Dalbeth N et al (2004) Clinical assessment of sacroiliitis and HLA-B27 are poor predictors of sacroiliitis diagnosed by magnetic resonance imaging in psoriatic arthritis. Rheumatology (Oxford) 43:85–88
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Akdeniz, O., Alaylı, G., Tosun, F.C. et al. Early spondyloarthropathy: scintigraphic, biological, and clinical findings in MRI-positive patients. Clin Rheumatol 27, 469–474 (2008). https://doi.org/10.1007/s10067-007-0730-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-007-0730-y