Bone scintigraphy in arthritis

Abstract

Advances in the knowledge base of rheumatology have been paralleled by the advances in imaging. These advances in imaging are typified by the early detection of the major rheumatic diseases prior to the onset of morphological changes and had major effects on the outcomes of treatment. Scintigraphy has allowed early detection of disease, especially in rheumatoid arthritis and the seronegative arthritides, allowing treatment with powerful drugs such as methotrexate and the biological agents. Serial studies, especially with the use of SPECT/CT, have the potential to monitor the effect of therapy, thereby allowing modification of therapy as required. The diminishing role of plain-film radiology in this scenario is inevitable. However, imaging has the potential to allow the tracking of immunological cellular traffic that is at the very heart of the pathophysiology of the rheumatic diseases. The fusion of scintigraphic imaging of these cellular and biochemical profiles with anatomical imaging modalities will allow disease to be tracked at a preclinical level, especially in individuals with a genetic predisposition to disease.