Other Rheumatic Osteoarthropathies and Soft Tissue Rheumatism Syndromes

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From among a larger group of rheumatic and similar osteoarthropathies, Sjogren's syndrome, Behcet's syndrome, systemic lupus erythematosus (SLE), tophaceous gouty arthritis, Char-cot's joint, and secondary hypertrophic osteo-arthropathy deserve appropriate descriptions since these disorders show 99mTc-MDP bone scintigraphic changes that suggest or often indicate the diagnosis. This is especially true in Sjogren's syndrome, Behcet's syndrome, SLE, and gouty arthritis, in which radiography often fails to yield a specific diagnostic sign in the early phase of disease.

The early radiographic manifestation of rheumatic osteoarthropathies is articular blurring with periarticular soft-tissue swelling, which is not specific (Fig. 12.1). Then, sub-chondral bone erosions, articular narrowing, cystic change, ankylosis, and deformity may follow in the later stage, which are also nonspecific. However, tophi with tophaceous bone erosions in gouty arthritis, bizarre disfiguring bone and joint changes in Charcot's joint, and lamellar periosteal thickening in secondary hypertrophic osteoarthritis are characteristic. On the other hand, both radiographic and scintigra-phic manifestations overlap when a rheumatic arthritis, Sjogren's syndrome in particular, is combined with rheumatoid arthritis.

As is well known whole-body scanning is useful for grasping the pattern of involvement of rheumatic arthritides, which is typically pau-ciarticular, focal, and asymmetrical (Fig. 12.2A). If combined with rheumatoid arthritis, however, the involvement becomes symmetrical and polyarticular (Fig. 12.2B). Pinhole scintigraphy can sensitively detect the early arthritic change

Full Body Scan Shows Arthritis

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Fig. 12.1 A, B The "wrapped bone" sign seen in Sjogren's syndrome synovitis on bone scintigraph. A Anteroposterior radiograph of the right knee in a 41-year-old woman with Sjogren's syndrome reveals diffuse para-articular soft-tissue swelling with a blurred joint (arrowheads). B Anterior pinhole scintigraph shows diffusely increased tracer uptake in the entire periarticular bones with the more prominent uptake in the peripheries (arrowheads)

Sjogren Finger

Fig. 12.2 A, B Whole-body bone scintigraphy for grasping involvement pattern of rheumatic arthritis. A Anterior whole-body bone scintigraph in Sjogren's syndrome combined with rheumatoid arthritis demonstrates symmetrical polyarthritis (arrows). B Anterior whole-

body bone scintigraph in a 61-year-old woman with psoriasis of the hands reveals asymmetrical pauciarticu-lar involvement of the finger joints (arrows). Knee joint changes are due to osteoarthritis unrelated to psoriasis (arrowheads)

Fig. 12.2 A, B Whole-body bone scintigraphy for grasping involvement pattern of rheumatic arthritis. A Anterior whole-body bone scintigraph in Sjogren's syndrome combined with rheumatoid arthritis demonstrates symmetrical polyarthritis (arrows). B Anterior whole-

Degenerative Arthritis The Whold Body

Fig. 12.3 Preradiographic demonstration of plantar fasciitis in Behcet's disease. Medial pinhole scintigraph of the painful right heel in a 32-year-old woman with known Behcet's disease shows a subtle, spotty tracer uptake in the medial process of the calcaneal tuberosity (arrowhead). Radiography was unremarkable (not shown)

characterized by diffuse synovial uptake with marginal accentuation (Fig. 12.1B). Similar findings may be seen in rheumatoid arthritis (Fig. 10.4) and acute infective arthritis (Fig. 8.5). Rheumatic-like disorders such as Beh├žet's syndrome may occasionally show spotty uptake in the knees and the plantar aspect of the calcaneus (Fig. 12.3), strongly resembling Reiter's en-thesopathy (Fig. 11.9) or psoriatic plantar fasciitis (Fig. 11.27), and such uptake frequently heralds the disease before radiographic changes appear.

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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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