Nuclear Medicine and Molecular Imaging

, Volume 53, Issue 4, pp 278–286 | Cite as

The Correlation Between Tenosynovitis Pattern on Two-Phase Bone Scintigraphy and Clinical Manifestation in Patients with Suspected Rheumatoid Arthritis

  • Hyung Jin Choi
  • Soo Jin Lee
  • Ji Young Kim
  • Yoon-Kyoung Sung
  • Yun Young ChoiEmail author
Original Article



To investigate the correlation between the tenosynovitis pattern on two-phase bone scintigraphy (2P-BS) and clinical manifestation in patients with suspected rheumatoid arthritis (RA).


2P-BS including technetium–99m-methylene diphosphonate blood pool and bone phase imaging in 402 consecutive patients with clinically suspected RA were retrospectively reviewed. According to 2010 RA Classification Criteria, patients were grouped as RA and non-RA. Visual assessment of all fingers, toes, wrists, and ankles on 2P-BS was performed. Clinical suspected tenosynovitis was evaluated on physical examination. Rheumatoid factor, anti-cyclic citrullinated protein antibody, C-reactive protein, and estimated sedimentation rate were obtained. Radiographic findings were also used to define early and established arthritis.


Tenosynovitis pattern was detected in 12.7% (51/402 patients) on 2P-BS. A total of 94.1% (48/51) were diagnosed as RA vs. 5.9% (3/51) as non-RA. Of the 48 RA patients with positive 2P-BS finding, 85.4% (41/48) had early arthritis and 14.6% (7/48) had established arthritis. On physical examination, tenosynovitis was suspected in 21.9% (88/402). A total of 56.8% (50/88) belonged to the RA group and 43.2% (38/88) to the non-RA group. The tenosynovitis pattern of 2P-BS and physical examination showed statistical difference and moderate agreement. The positive tenosynovitis pattern on 2P-BS represented up to 26.408 of odds ratio which was highest among the RA-associated factors.


Tenosynovitis pattern on 2P-BS was more commonly detected in the RA group and was more frequently associated with early arthritis pattern. Therefore, 2P-BS could give additional information for the detection of subclinical tenosynovitis in early or preclinical RA patients.


Tenosynovitis Bone scintigraphy MDP Rheumatoid arthritis 


Compliance with Ethical Standards

Conflict of Interest

Hyung Jin Choi, Soo Jin Lee, Ji Young Kim, Yoon-Kyoung Sung, and Yun Young Choi declare no conflict of interest.

Ethical Statement

All procedures followed were performed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

The study design of the retrospective analysis and exemption of informed consent were approved by the Institutional Review Board of Hanyang University Medical Center (HYUH 2018-11-001).


  1. 1.
    Sandrock D, Backhaus M, Burmester G, Munz DL. Imaging techniques in rheumatology: scintigraphy in rheumatoid arthritis. Z Rheumatol. 2003;62:476–80.CrossRefGoogle Scholar
  2. 2.
    Kim JY, Choi YY, Kim CW, Sung YK, Yoo DH. Bone scintigraphy in the diagnosis of rheumatoid arthritis: is there additional value of bone scintigraphy with blood pool phase over conventional bone scintigraphy? J Korean Med Sci. 2016;31:502–9.CrossRefGoogle Scholar
  3. 3.
    Gray RG, Gottlieb NL. Hand flexor tenosynovitis in rheumatoid arthritis. Prevalence, distribution, and associated rheumatic features. Arthritis Rheum. 1977;20:1003–8.CrossRefGoogle Scholar
  4. 4.
    Rowbotham EL, Freeston JE, Emery P, Grainger AJ. The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis. Eur Radiol. 2016;26:444–50.CrossRefGoogle Scholar
  5. 5.
    Kleyer A, Krieter M, Oliveira I, Faustini F, Simon D, Kaemmerer N, et al. High prevalence of tenosynovial inflammation before onset of rheumatoid arthritis and its link to progression to RA-A combined MRI/CT study. Semin Arthritis Rheum. 2016;46:143–50.CrossRefGoogle Scholar
  6. 6.
    Bukhari MA, Wiles NJ, Lunt M, Harrison BJ, Scott DG, Symmons DP, et al. Influence of disease-modifying therapy on radiographic outcome in inflammatory polyarthritis at five years: results from a large observational inception study. Arthritis Rheum. 2003;48:46–53.CrossRefGoogle Scholar
  7. 7.
    Davies A, Cifaldi MA, Segurado OG, Weisman MH. Cost-effectiveness of sequential therapy with tumor necrosis factor antagonists in early rheumatoid arthritis. J Rheumatol. 2009;36:16–26.CrossRefGoogle Scholar
  8. 8.
    Emery P, Seto Y. Role of biologics in early arthritis. Clin Exp Rheumatol. 2003;21:S191–4.Google Scholar
  9. 9.
    Hammer HB, Kvien TK, Terslev L. Tenosynovitis in rheumatoid arthritis patients on biologic treatment: involvement and sensitivity to change compared to joint inflammation. Clin Exp Rheumatol. 2017;35:959–65.Google Scholar
  10. 10.
    Pincus T, O'Dell JR, Kremer JM. Combination therapy with multiple disease-modifying antirheumatic drugs in rheumatoid arthritis: a preventive strategy. Ann Intern Med. 1999;131:768–74.CrossRefGoogle Scholar
  11. 11.
    van der Heide A, Jacobs JW, Bijlsma JW, Heurkens AH, van Booma-Frankfort C, van der Veen MJ, et al. The effectiveness of early treatment with “second-line” antirheumatic drugs. A randomized, controlled trial. Ann Intern Med. 1996;124:699–707.CrossRefGoogle Scholar
  12. 12.
    van Dongen H, van Aken J, Lard LR, Visser K, Ronday HK, Hulsmans HM, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2007;56:1424–32.CrossRefGoogle Scholar
  13. 13.
    Ammitzboll-Danielsen M, Ostergaard M, Naredo E, Terslev L. Validity and sensitivity to change of the semi-quantitative OMERACT ultrasound scoring system for tenosynovitis in patients with rheumatoid arthritis. Rheumatology (Oxford). 2016;55:2156–66.CrossRefGoogle Scholar
  14. 14.
    Boutry N, Larde A, Lapegue F, Solau-Gervais E, Flipo RM, Cotten A. Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis. J Rheumatol. 2003;30:671–9.Google Scholar
  15. 15.
    Danielsen MA. Ultrasonography for diagnosis, monitoring and treatment of tenosynovitis in patients with rheumatoid arthritis. Dan Med J. 2018;65.Google Scholar
  16. 16.
    Haavardsholm EA, Ostergaard M, Ejbjerg BJ, Kvan NP, Kvien TK. Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis: reliability in a multireader longitudinal study. Ann Rheum Dis. 2007;66:1216–20.CrossRefGoogle Scholar
  17. 17.
    Hmamouchi I, Bahiri R, Srifi N, Aktaou S, Abouqal R, Hajjaj-Hassouni N. A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis. BMC Musculoskelet Disord. 2011;12:91.CrossRefGoogle Scholar
  18. 18.
    Navalho M, Resende C, Rodrigues AM, Ramos F, Gaspar A, Pereira da Silva JA, et al. Bilateral MR imaging of the hand and wrist in early and very early inflammatory arthritis: tenosynovitis is associated with progression to rheumatoid arthritis. Radiology. 2012;264:823–33.CrossRefGoogle Scholar
  19. 19.
    Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Ostergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003;48:955–62.CrossRefGoogle Scholar
  20. 20.
    Zabotti A, Salvin S, Quartuccio L, De Vita S. Differentiation between early rheumatoid and early psoriatic arthritis by the ultrasonographic study of the synovio-entheseal complex of the small joints of the hands. Clin Exp Rheumatol. 2016;34:459–65.Google Scholar
  21. 21.
    Stein F, Miale A Jr, Stein A. Enhanced diagnosis of hand and wrist disorders by triple phase radionuclide bone imaging. Bull Hosp Jt Dis Orthop Inst. 1984;44:477–84.Google Scholar
  22. 22.
    Sopov W, Rozenbaum M, Rosner I, Groshar D. Scintigraphy of de Quervain's tenosynovitis. Nucl Med Commun. 1999;20:175–7.CrossRefGoogle Scholar
  23. 23.
    Kaya M, Tuna H, Tuncbilek N, Cermik TF, Sardogan K. Scintigraphic findings in plant thorn tenosynovitis of finger. Clin Nucl Med. 2008;33:131–2.CrossRefGoogle Scholar
  24. 24.
    Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69:1580–8.CrossRefGoogle Scholar
  25. 25.
    Byrt T, Bishop J, Carlin JB. Bias, prevalence and kappa. J Clin Epidemiol. 1993;46:423–9.CrossRefGoogle Scholar
  26. 26.
    Tooth LR, Ottenbacher KJ. The kappa statistic in rehabilitation research: an examination. Arch Phys Med Rehabil. 2004;85:1371–6.CrossRefGoogle Scholar
  27. 27.
    Spitznagel EL, Helzer JE. A proposed solution to the base rate problem in the kappa statistic. Arch Gen Psychiatry. 1985;42:725–8.CrossRefGoogle Scholar
  28. 28.
    Wikimedia Commons contributors. Gray’s Anatomy plates, Wikimedia Commons, the free media repository. Accessed 6 Dec 2018.
  29. 29.
    Leslie WD. The scintigraphic appearance of de Quervain tenosynovitis. Clin Nucl Med. 2006;31:602–4.CrossRefGoogle Scholar
  30. 30.
    Ansell BM, Bywaters EG. Finger contractures due to tendon lesions as a mode of presentation of rheumatoid arthritis. Ann Rheum Dis. 1953;12:283–9.CrossRefGoogle Scholar
  31. 31.
    Eshed I, Feist E, Althoff CE, Hamm B, Konen E, Burmester GR, et al. Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis. Rheumatology (Oxford). 2009;48:887–91.CrossRefGoogle Scholar
  32. 32.
    Mottonen TT. Prediction of erosiveness and rate of development of new erosions in early rheumatoid arthritis. Ann Rheum Dis. 1988;47:648–53.CrossRefGoogle Scholar
  33. 33.
    Jain A, Nanchahal J, Troeberg L, Green P, Brennan F. Production of cytokines, vascular endothelial growth factor, matrix metalloproteinases, and tissue inhibitor of metalloproteinases 1 by tenosynovium demonstrates its potential for tendon destruction in rheumatoid arthritis. Arthritis Rheum. 2001;44:1754–60.CrossRefGoogle Scholar
  34. 34.
    Lindegaard HM, Vallo J, Horslev-Petersen K, Junker P, Ostergaard M. Low-cost, low-field dedicated extremity magnetic resonance imaging in early rheumatoid arthritis: a 1-year follow-up study. Ann Rheum Dis. 2006;65:1208–12.CrossRefGoogle Scholar
  35. 35.
    Rantapaa-Dahlqvist S, de Jong BA, Berglin E, Hallmans G, Wadell G, Stenlund H, et al. Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheum. 2003;48:2741–9.CrossRefGoogle Scholar

Copyright information

© Korean Society of Nuclear Medicine 2019

Authors and Affiliations

  1. 1.Department of Nuclear MedicineHanyang University Medical CenterSeoulSouth Korea
  2. 2.Department of Nuclear MedicineHanyang University Guri HospitalGuri-siSouth Korea
  3. 3.Department of RheumatologyHanyang University Hospital for Rheumatic DiseasesSeoulSouth Korea

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