Seyhan KARAÇAVUŞ, Mehmet UÇAR, Mehmet Fatih GEÇER, Özlem BALBALOĞLU, Ömer NAS, Ümit SARP

Romatoid artrit'te kemik sintigrafisi bulguları, DAS28 skoru ve biyokimyasal parametrelerin karşılaştırılması

Amaç: Romatoid artrit (RA), eklemlerde ilerleyici hasarla karakterize kronik inflamatuar ve otoimmun bir hastalıktır. Bu çalışmada RA'lı hastalarda klinik, biyokimyasal ve sintigrafik bulguların karşılaştırılması amaçlanmıştır. Materyal ve metod: Çalışmaya American College of Rheumatology (ACR) kriterlerine göre RA tanısı almış 62 hasta (K/E: 44/8, yaş ortalaması 51,8±11,1; yaş aralığı 31-77) dahil edilmiştir. Tüm hastalar DAS28 (Disease Activity Score) skorlamasına göre hastalar iki gruba ayrıldı; DAS28 skoru ≥3,2 olanlar hastalık aktivitesi yüksek (Grup 1), <3,2 olanlar hastalık aktivitesi düşük (Grup 2) olarak tanımlandı. Tüm hastalara Tc99m-MDP ile yapılan kemik sintigrafisi yapıldı. Kan havuzu ve geç statik fazda izlenen artmış aktivite tutulumları pozitif bulgu olarak değerlendirildi. Ayrıca hastaların serum biyokimyasal enflamatuar belirteçlerine (CRP, sedimentasyon, RF) bakıldı. Klinik bulgular Health Assessment Questionnaire (HAQ) ve Ritchie articular index (RAI) ile değerlendirildi. Bulgular: DAS28 skoru yüksek olan Grup 1'de skoru düşük olan Grup 2'ye göre daha fazla sayıda periferik eklem tutulumu (11/8 eklem) gözlendi (p<0.05). Hastalık aktivite skoru yüksek olan grupta klinik skor arttıkça eklem tutulumu sayısı (r=0.5,p=0.019) ve biyokimyasal parametrelerde artış izlendi (r=0.7,p<0.001). DAS28 skoru düşük bulunan 13 hastanın 6'sında ise kemik sintigrafisinde klinik skoru yüksek olan gruptakine benzer sayıda periferik eklem tutulumu saptandı. Sonuç: Romatoid artrit tanılı hastalarda, tüm vücut kemik sintigrafisi, aktif hastalığın bulunduğu periferik eklemlerin tek seansta değerlendirilmesinde ve henüz belirgin klinik bulgu göstermeyen eklemlerin tespitinde, klinik yaklaşıma önemli katkıda bulunan, ucuz ve kolay uygulanabilen bir yöntemdir.

Anahtar Kelimeler:

Romatoid artrit, DAS28 skoru, kemik sintigrafisi, biyokimyasal parametreler.

Bone scintigraphy, DAS 28 score and biochemical parameters in patients with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory and autoimmune disease characterized by progressive damage of joints. In this study, we investigated the relationship between the disease activity scores and bone scan findings and biochemical parameters in patients with RA. Method: Sixty two patients (F/M: 44/8, age 51,8±11,1; range 31-77) diagnosed with RA according to the American College of Rheumatology (ACR) criteria were included in the study. All patients were divided to two groups regarding their DAS28 score; Group 1 was DAS28 score≥3,2 and Group 1 was DAS28 score<3,2. The whole body bone scintigraphy with Tc99m-MDP (TVKS) was performed all subject. A increased uptake on any joint in blood pool phase and late static phase of bone scan was evaluated as a positive result. Laboratory data including the erythrocyte sedimentation rate and C-reactive protein were recorded. The clinical parameters were assessed by the Health Assessment Questionnaire (HAQ) and Ritchie articular index (RAİ). Results: The mean number of peripheral joint involvement was higher in Group 1 than in Group 2 (11/8; p<0.05). Number of joint involvement (r=0.5,p=0.019) and biochemical parameters (r=0.7,p<0.001) were increased with clinical score in Higher disease activity score group. In 6 of 13 patients of lower DAS28 group, number of peripheral joint involvement were similar to high DAS28 group. Conclusion: Whole body bone scintigraphy is a cheap and easy method, that contributes a lot to the clinical approach in patients with rheumatoid arthritis, in the evaluation of peripheral joints in a single session and determining the joints those not expressing significant clinical findings yet.

Keywords:

Rheumatoid arthritis, DAS28 index, bone scintigraphy, biochemical parameters,

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