Introduction of a metabolic joint asymmetry score derived from conventional bone scintigraphy

 

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Summary

Aim: Clinical differentiation of psoriatic arthritis (PsA) and rheumatoid arthritis (rA) based on the pattern of joint involvement can be difficult; the frequent form of PsA with polyarthritis of the peripheral joints may sometime resemble rA. We investigated a metabolic joint asymmetry score (MJAS), reflecting the overall asymmetric joint involvement on conventional bone scintigraphy, for differentiating PsA from rA in patients presenting with peripheral polyarthritis. Patients, methods: 106 patients (n = 61, PsA; n = 45, rA) with peripheral polyarthritis (≥ 5 joints) as well as 26 control subjects with no history of chronic joint disorders were analyzed. The intensity of articular ^99mTc-MDP uptake in 40 peripheral joint pairs was scored regarding the bilateral difference of each joint based on a scale of 0–2 (no significant, moderate, and marked asymmetry, respectively). The patient's MJAS was defined as the sum of uptake difference scores of all joint pairs. The association of MJAS with the underlying condition (Psoriasis criteria, Revised Criteria of the ACR) was examined. Results: 5280 peripheral joint pairs were investigated. There was no significant difference in the total number of involved joints in PsA 15.0 ± 8.2 versus rA 17.5 ± 8.8 patients (p = 0.132), but significantly less involvement in the control group (6.7 ± 5.0, p < 0.001). MJAS was markedly higher in PsA (17.0 ± 9.6) than in rA (4.8 ± 3.9, p < 0.001), and correlated with the total number of involved joints in PsA (r = 0.516, p < 0.001), but not in rA (r = 0.078, p = 0.380). The MJAS disparity between PsA and rA persisted after exclusion of the DIP joints (14.4 ± 7.7 vs. 4.4 ± 3.3; p<0.001). Conclusions: The new reproducible semi-quantification method for the asymmetry of metabolic joint involvement permits differentiation of psoriatic from rheumatoid peripheral arthritis with MJAS being markedly higher in patients with PsA as compared to rA patients. The score may offer an effective complementary tool for characterizing patients with peripheral polyarthritis.

Zusammenfassung

Ziel: Die klinische Differenzierung der Psoriasis-Arthritis (PsA) von der rheumatoiden Arthritis (rA) basierend auf dem Gelenkbefallsmuster kann schwierig sein; die häufig auftretende Form der PsA mit Polyarthritis der peripheren Gelenke kann der rA ähneln. Wir untersuchten den Nutzen einer Asymmetrie-Skala für den metabolischen Gelenksbefall (MJAS), welche die Gesamtasymmetrie der Gelenkbeteiligung in der konventionellen Skelettszintigrafie reflektiert, zur Differenzierung der PsA von der rA bei Patienten mit peripherer Polyarthritis. Patienten, Methoden: 106 Patienten (n = 61, PsA; n = 45, rA) mit peripherer Polyarthritis (≥5 Gelenke) sowie 26 Kontrollen ohne chronische Gelenkerkrankung wurden eingeschlossen. Die Intensität der artikulären ^99mTc-MDP-Speicherung in 40 peripheren Gelenkpaaren wurde hinsichtlich der bilateralen Differenz graduiert, pro Gelenkpaar jeweils mit einem Score von 0 bis 2 (keine signifikante, moderate oder ausgeprägte Asymmetrie). Der MJAS des Patienten definierte sich aus der Summe der Uptake-Differenz Scores aller Gelenkpaare. Die Assoziation des MJAS mit der zugrundeliegenden Erkrankung (Psoriasis criteria, Rivised Criteria of the ACR) wurde statistisch getestet. Ergebnisse: 5280 periphere Gelenkpaare wurden untersucht. Die mittlere Anzahl der betroffenen Gelenke war ähnlich hoch in PsA (15.0 ± 8.2) und rA (17.5 ± 8.8) Patienten (p = 0.132), aber deutlich niedriger in der Kontrollgruppe (6.7 ± 5.0, p < 0.001). Das mittlere MJAS war deutlich höher bei der PsA (17.0 ± 9.6) als bei der rA (4.8 ± 3.9, p < 0.001), und korrelierte mit der Anzahl der betroffenen Gelenke bei der PsA (r = 0.516, p < 0.001), nicht jedoch bei der rA (r = 0.078, p = 0.380). Die MJAS-Diskrepanz zwischen PsA und rA persistierte auch nach Ausschluss der DIP Gelenke (14.4 ± 7.7 vs 4.4 ± 3.3; p < 0.001). Schlussfolgerungen: Die reproduzierbare semiquantitative Methodik zur Erfassung der Asymmetrie der metabolischen Gelenkbeteiligung erlaubt die Differenzierung der peripheren Psoriasis von der rheumatoiden Arthritis; das MJAS ist bei der PsA deutlich höher und bietet die Möglichkeit zur komplementären Charakterisierung von Patienten mit peripherer Polyarthritis.

^* Both authors contributed equally to this work.

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