Nuclear Angiography in Rheumatoid Arthritis

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Fig. 10.49 Value of whole-body bone scintigraphy in the diagnosis of juvenile rheumatoid arthritis. Anterior whole-body bone scan in an 18-year-old female with polyarthritis clearly shows prominent symmetrical multiarticular tracer uptake (arrows)

Nuclear angiography is widely used for a dynamic assessment of vascular alteration in rheumatoid arthritis, especially in the early stage (Hopfner et al. 2002, 2004). As in any inflammatory or infective diseases of the skeleton, nuclear angiography provides unique information on the disease activity of rheumatoid arthritis using visual or quantitative analysis of the blood flow, blood pool, and tracer uptake

Rheumatoid Arthritis Nuclear

Fig. 10.50A, B Nuclear angiography in rheumatoid arthritis. A Nuclear arteriogram of the right hand with rheumatoid arthritis shows areas of increased vascularity in the intercarpal and first through third carpometacar-pal joints (arrows). B Static bone scan reveals increased uptake in inflamed focus of rheumatoid arthritis (arrows)

Fig. 10.50A, B Nuclear angiography in rheumatoid arthritis. A Nuclear arteriogram of the right hand with rheumatoid arthritis shows areas of increased vascularity in the intercarpal and first through third carpometacar-pal joints (arrows). B Static bone scan reveals increased uptake in inflamed focus of rheumatoid arthritis (arrows)

both in the articular bones and the periarticu-lar soft-tissue structures. Actually, synovitis with pannus is an ideal target of nuclear angi-ography since the synovial interface with the cartilage and bone is the primary "attack zone" for rheumatoid arthritis (Feldmann et al. 1990; de Bois et al. 1995).

Pathologically, synovial hypertrophy occurs following edema and blood vessel proliferation due to the coordinated action of vascular and cellular responses during the first weeks of rheumatoid arthritis (Cotran et al. 1989; Stevens et al. 1991). Indeed, nuclear angiography shows increased blood flow to and blood pool in the inflamed synovium and chondro-osse-ous zone on rheumatoid joints (Fig. 10.50A). The tips of the fingers may become flushed with increased blood flow. Such vasodilatation could be related to systemic microcirculatory compromise that has been known to occur in rheumatoid arthritis (Rothschild and Masi 1982), and more specifically to endothelial dysfunction (Vaudo et al. 2004). The equilibrium phase (static) bone scan reveals increased tra cer uptake in inflamed focus of rheumatoid arthritis (Fig. 10.50B).

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