Background Osteoarthritis (OA) is the most common cause of musculoskeletal diseases in the developed countries. The diagnosis of OA is usually dependent on clinical and radiological evaluations which have some limitations in measuring the outcome.
Objectives The aims of this study were to evaluate the predictive role of bone scintigraphy in OA, and to study the relationship with age and severity of the disease.
Methods Ninety-nine female subjects were included in this study. Conventional x-rays of the hand, knee, hip and lumbar regions were obtained from each subjects. According to Kellgren and Lawrence Grading System the radiological score of the joint which had the highest grade was accepted as the Maximum Radiological Score (MRS). A bone scan was performed for each subjects 4 h after the injection of 740 MBq of technetium ? 99m-MDP. Spot images of hand, knee, lumbar vertabrae and pelvis were acquired using a gamma camera (Toshiba GCA 601). Besides the increased or normal uptake of activity at the affected joints, the ratios of lesion/non-lesion were also calculated. In the areas where the increased uptake of activity were present, the maximum lesion/non-lesion ratio was accepted as Maximum Scintigraphic Score (MSS). According to the American College of Rheumatology- clinical and radiological ? criteria for diagnosis of OA 46 patients were included in OA group (Group 1) and 53 patients were included in control group (Group 2). The Lequesne Index was used to determine the severity of the disease.
Results All patients in group 1 and 31 patients in group 2 had knee pain and the mean duration of pain was 51.6+77.5 months in group 1 and 23.4+46.5 months in group 2. The mean Body Mass Index (BMI) was 31.7+5.0 in group 1 and 36.7+4.0 in group 2. According to the results of scintigraphic evaluation, healthy controls were separated into two groups. In group 2A patients who had an increase in uptake at least one joint and in group 2B patients who had no uptake. The mean MSS was 4.2+1.4 in group 1 and 3.3+1.6 in group 2A. Also the mean MRS of the patients in group 1 were 2.9+0.9 and 0.6+0.5, 0.2+0.4 in group 2A and 2B respectively. The mean score of the Lequesne Index was 8,9+3,6 in group 1 patients. There was a positive correlation between age and MSS (p < 0,05) and BMI and MRS (p < 0,05). Also there was a strong correlation between Lequesne OA Severity Index Score the age of the patients in group 1 but no correlation with the MSS. According to the clinical and/or radiological criteria sensitivity of bone scintigraphy was 98.2%, specifity was 57.1%, positive predictive value was 76% and negative predictive value was 96%.
Conclusion Our results suggest that 99 m technetium scintigraphy is a better quantifying method in assessing the changes of OA especially in early cases.
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