Sjogrens Syndrome

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Sjogren's syndrome consists of keratoconjunctivitis sicca, xerostomia, and rheumatoid arthritis, and is considered to be a generalized autoimmune exocrinopathy (Strand and Talal 1980). Like most autoimmune diseases, Sjogren's syndrome occurs predominantly in women in fourth to seventh decades of life. The syndrome may be either primary or secondary to rheumatoid arthritis and less commonly SLE. Arthritic involvement may or may not be present, and when obvious it is almost always due to rheumatoid arthritis, manifesting as periarticular soft-tissue swelling in the early stage (Fig. 12.1) and erosions, articular narrowing, and subchondral intraosseous cyst in the chronic stage. Bone scintigraphy of Sjogren's syndrome complicated with rheumatoid arthritis demonstrates symmetrical tracer uptake in both large and small joints of the limbs and digits (Fig. 12.2A). To be exact, such polyar-thritic manifestation is not due to Sjogren's syndrome but rheumatoid arthritis. Pinhole scintigraphy shows the typical "wrapped bone" sign with marginal uptake that may also be due to early rheumatoid synovitis (Fig. 12.1B). On the other hand, pinhole scintigraphy can diagnose retrocalcaneal enthesitis with heel pad swelling (Fig. 12.4A), which is extremely subtle and difficult to detect by radiography (Fig. 12.4B).

Heel Pad Syndrome

Fig. 12.4A, B Usefulness of bone scintigraphy in Behçet's syndrome. A Lateral radiograph of the left calcaneus in a 29-year-old woman shows suspicious soft-tissue thickening in the heel pad (?) without local bone change. B Lateral pinhole scintigraph reveals diffuse reactive tracer uptake in the lower retrocalcaneal surface (arrow) with diffuse extension to the heel pad denoting mild inflammation (arrowheads)

Fig. 12.4A, B Usefulness of bone scintigraphy in Behçet's syndrome. A Lateral radiograph of the left calcaneus in a 29-year-old woman shows suspicious soft-tissue thickening in the heel pad (?) without local bone change. B Lateral pinhole scintigraph reveals diffuse reactive tracer uptake in the lower retrocalcaneal surface (arrow) with diffuse extension to the heel pad denoting mild inflammation (arrowheads)

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