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Detection of alveolar epithelial injury by Tc-99m DTPA radioaerosol inhalation lung scan in rheumatoid arthritis patients

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Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disorder primarily involving the joints. Lung alterations in RA may be primary or secondary to pharmacological treatments and may involve the alveoli, interstitium, airways and/or pleura. Technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA) aerosol inhalation scintigraphy is a sensitive and noninvasive test commonly employed to assess pulmonary epithelial membrane permeability. The purpose of the this study was a) to investigate the changes of pulmonary alveolar epithelial permeability in patients with RA, b) to determine the relationship between the clearance rate of Tc-99m DTPA and pulmonary function test (PFT) results, and c) to determine the relationship between the clearance rete of Tc-99m DTPA and clinical parameters of disease. Twenty-five patients with RA but without lung alterations were included in the study. The patients were 22 females, and 3 males; mean age 53.6 ± 8.7 years. Technetium-99m DTPA aerosol inhalation scintigraphy was performed on the study and healthy control groups. Clearance half times (T1/2) were calculated by placing a mono-exponential fit on the curves. Penetration index (PI) was calculated on the first-minute image. There were no significant differences in the mean T1/2 or mean PI values between the RA patients and control subjects. No correlation was found between the mean T1/2 values of Tc-99m DTPA clearance and activity of RA, clinical values, or the spirometric measurements except FEV1/FVC and functional status in RA patients (p = 0.02, p = 0.01, respectively). However, a weak correlation was found between duration of disease and T1/2 values of Tc-99m DTPA clearance (p = 0.006). PI values tended to correlate with FEF25-75, although, this was not statistically significant (p = 0.057). This study shows that no changes occur in alveolar-capillary permeability in RA patients without lung alterations.

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References

  1. 1.

    Ruddy S, Harris ED, Sledge C. Kelley’s Textbook of Rheumatology. In: Harris ED (ed).Rheumatoid Arthritis. Sixth edition, Saunders Comp., 2001: 921–1001.

  2. 2.

    Gabriel SE. The epidemiology of rheumatoid arthritis.Rheum Dis Clin North Am 2001; 27:269–281.

  3. 3.

    Triggiani M, Granata F, Giannattasio G, Borrelli I, de Paulis A, Marone G. Lung involvement in rheumatoid arthritis.Sarcoidosis Vasc Diffuse Lung Dis 2003; 20:171–179.

  4. 4.

    Coates G, O’Brodovich H. Pulmonary alveolar capillary permeability and fluid exchange. In: Loken MK (ed).Pulmonary nuclear medicine. Los Altos, CA; Appleton and Lange, Inc., 1987:304–326.

  5. 5.

    Suskind H. Technetium-99m-DTPA aerosol to measure alveolar-capillary membrane permeability.J Nucl Med 1994; 35:207–209.

  6. 6.

    Jones JG, Minty BD, Lawler P, Hulands G, Crawley JC, Veall N. Increased alveolar epithelial permeability in cigarette smokers.Lancet 1980; 12:66–68.

  7. 7.

    Kaya M, Salan A, Tabakoglu E, Aydogdu N, Berkarda S. The bronchoalveolar epithelial permeability in house painters as determined by Tc-99m DTPA aerosol scintigraphy.Ann Nucl Med 2003; 17:305–308.

  8. 8.

    Okudan B, Han S, Baldemir M, Yildiz M. Detection of alveolar epithelial injury by99mTc-DTPA radioaerosol inhalation lung scan following blunt chest trauma.Ann Nucl Med 2004; 18:310–315.

  9. 9.

    Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Associations 1987 revised criteria for the classification of rheumatoid arthritis.Arthritis Rheum 1988; 31:315–324.

  10. 10.

    Comstock GW, Tockman MS, Helsing KJ, Hennesy KM. Standardized respiratory questionnaires: comparison of the old with the new.Am Rev Respir Dis 1979; 119:45–53.

  11. 11.

    Felson DT, Anderson JJ, Boers M, et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials.Arthritis Rheum 1993; 36:729–740.

  12. 12.

    Ellman P, Ball RE. A rheumatoid disease with joint and pulmonary manifestations.Brit Med J 1948; 2:816–820.

  13. 13.

    Aronoff A, Bywaters EG, Fearnley GR. Lung lesions in rheumatoid arthritis.Brit Med J 1955; 23:228–232.

  14. 14.

    Cervantes-Perez P, Toro-Perez AH, Rodriguez-Jurado P. Pulmonary involvement in rheumatoid arthritis.JAMA 1980; 243:1715–1719.

  15. 15.

    Cortet B, Flipo RM, Remy-Jardin M, et al. Use of high resolution computed tomography of the lungs in patients with rheumatoid arthritis.Ann Rheum Dis 1995; 54:815–819.

  16. 16.

    Harmon KR, Leatherman JW. Respiratory manifestations of connective tissue disease.Semin Respir Infect 1988; 3:258–273.

  17. 17.

    Tanoue LT. Pulmonary manifestations of rheumatoid arthritis.Clin Chest Med 1998; 19:667–685.

  18. 18.

    Linstow M, Ulrik CS, Kriegbaum NJ, Backer V, Oxholm P. An 8-year follow-up study of pulmonary function in patients with rheumatoid arthritis.Rheumatol Int 1994; 14:115–158.

  19. 19.

    Dolovich MB, Jordana M, Newhouse MT. Methodologic considerations in mucociliary clearance and lung epithelial absorption measurements.EurJ Nucl Med 1987; 13:S45–52.

  20. 20.

    Collins RL, Turner RA, Johnson AM, Whitley NO, McLean RL. Obstructive pulmonary disease in rheumatoid arthritis.Arthritis Rheum 1976; 19:623–628.

  21. 21.

    Banks J, Banks C, Cheong B, et al. An epidemiological and clinical investigation of pulmonary function and respiratory Symptoms in patients with rheumatoid arthritis.Q J Med 1992; 85:795–806.

  22. 22.

    Linstow M, Ulrik CS, Kriegbaum NJ, Backer V, Oxholm P. An 8-year follow-up study of pulmonary function in patients with rheumatoid arthritis.Rheumatoid Int 1994; 3:115–118.

  23. 23.

    Geddes DM, Webley M, Emerson PA. Airways obstruction in rheumatoid arthritis.Ann Rheum Dis 1979; 38:222–225.

  24. 24.

    Hassan WU, Keaney NP, Holland CD, Kelly CA. Bronchial reactivity and airflow obstruction in rheumatoid arthritis.Ann Rheum Dis 1994; 53:511–514.

  25. 25.

    Cosio M, Ghezzo H, Hogg JC. The relations between structural changes in small airways and pulmonary function tests.N Engl J Med 1978; 298:1277–1281.

  26. 26.

    Berend N, Wright JL, Thurlbeck WM, Marlin GE, Woolcock AJ. Small airways disease: reproducibility of measure- ments and correlation with lung function.Chest 1981; 79:263–268.

  27. 27.

    Rajasekaran BA, Shovlin D, Lord P, Kelly CA. Interstitial lung disease in patients with rheumatoid arthritis: a comparison with cryptogenic fibrosing alveolitis.Rheumatology (Oxford) 2001; 40:1022–1025.

  28. 28.

    Scherak O, Popp W, Kolarz G, Wottawa A, Ritschka L, Braun O. Bronchoalveolar lavage and lung biopsy in rheumatoid arthritis.In vivo effects of disease modifying antirheumatic drugs.J Rheumatol 1993; 20:944–949.

  29. 29.

    Guidelines for the management of rheumatoid arthritis. American College of Rheumatology Ad Hoc Committee on Clinical Guidelines.Arthritis Rheum 1996; 39:713–722.

  30. 30.

    Kolarz G, Scherak O, Popp W, et al. Bronchoalveolar lavage in rheumatoid arthritis.Br J Rheumatol 1993; 32:556.

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Correspondence to Berna Okudan or Mehmet Şahİn or Feride Meltem Özbek or Ali Ümit Keskİn or Erkan Cüre.

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Okudan, B., Şahİn, M., Özbek, F.M. et al. Detection of alveolar epithelial injury by Tc-99m DTPA radioaerosol inhalation lung scan in rheumatoid arthritis patients. Ann Nucl Med 19, 455 (2005). https://doi.org/10.1007/BF02985572

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Key words

  • Tc-99m DTPA aerosol inhalation scintigraphy
  • clearance
  • rheumatoidarthritis
  • alveolar epithelial injury
  • pulmonary permeability