Generalized osteoarthritis designates a multiarticular involvement pattern of five or more joints at one time with osteoarthritis. It is divided into primary and nodal type according to the absence or presence of Heberden's nodes. Kellgren et al. (1963) have reported high rates of its occurrence in both male relatives (36%) and female relatives (49%) compared to respec-
Fig. 9.52 Value of whole-body bone scintigraphy in the diagnosis of generalized osteoarthritis. Anterior (left) and posterior (right) whole-body bone scans in a 56-year-old female show asymmetrical multiarticular involvement including the lower lumbar spine
Fig. 9.52 Value of whole-body bone scintigraphy in the diagnosis of generalized osteoarthritis. Anterior (left) and posterior (right) whole-body bone scans in a 56-year-old female show asymmetrical multiarticular involvement including the lower lumbar spine tive expected rates of 17% and 26%. Joints commonly involved include the apophyseal joints of the spine, the knees, the proximal in-terphalangeal joints of the finger, the first car-pometacarpal joint, and the first tarsometatar-sal joint (Kellgren and Moore 1952). The hips, wrists, and lateral metatarsophalangeal joints are also involved but less commonly.
For an efficient clinical investigation of this condition both radiography and scintigraphy are to be performed at the same time. Radiography is advantageous for the delineation of morphological changes such as bone erosion, sclerosis, and articular narrowing and the whole-body scintigraphy is the only available imaging method for panoramic observation of multiarticular disease (Fig. 9.52). In addition, pinhole scintigraphy can uniquely provide me-
Fig. 9.53A, B Magnified scintigraphy can uniquely provide metabolic information on the individual osteoar-thritis. A Dorsal scintigraph of both wrists and hands show tracer uptake to be more intense in sites of active osteoarthritis (arrows). B Anterior pinhole scan of both knees with osteoarthritis reveals different area sizes and uptake intensities between two joints reflecting difference of disease extent and intensity (arrows)
tabolic information on the individual osteoarthritis (Fig. 9.53).
Essential radiographic features are not dissimilar to those of osteoarthritis in other joints except for multiarticular involvement, and include articular narrowing, eburnation, cyst formation, and phalangeal joint osteophytosis with soft-tissue thickening. Periarticular osteo-phytic excrescences are termed Heberden's nodes when located on the distal interphalan-geal joints and Bouchard's nodes when located on the proximal interphalangeal joints.
Whole-body scanning is ideally suited to the diagnosis of multiple joint involvement spread in the lumbar spine, knees, fingers, wrists, and ankles (Fig. 9.52). On the other hand, pinhole scintigraphy permits semiquantitative assessment of the extent and activity of individual arthritis by observing the intensity of tracer uptake in the individual arthritis (Fig. 9.53). Thus, arthritis in the active phase accumulates tracer intensely and in the dormant phase accumulates little tracer.
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