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Abstract
Peripheral vascular occlusive disease & rheumatoid arthritis are common in older patients and the effect of coexistence of these diseases on patient’s health hasn’t been vigorously investigated. Technetium 99M-Methoxyisobutyl isonitrile (Tc-99MIBI) is a nonparticular radiopharmaceutical agent that does not necessitate intra-arterial administration and has been frequently used for the investigation of peripheral vascular disease by evaluating the perfusion reserve in the lower limbs.
Aim of work: The aim of this study is to detect the presence of sub clinical peripheral vascular disease in rheumatoid arthritis patients by measuring the perfusion reserve of lower limb of those patients using Tc-99 MIBI.
Patients and methods: This study included 25 patients with RA and 25 control group. Of the 25 patients with RA, 13 patients were receiving corticosteroids and 12 patients were not receiving corticosteroids. Database for every patient included full history taking, clinical examination, relevant laboratory tests including lipid profile and Tc-99 MIBI perfusion scan for lower limbs. Each subject flexed her right foot maximally dorsally and plantarly 30 times. In the middle of this exercise, 2 mCi of Tc-99 MIBI was injected intravenously. Three minutes after the injection, posterior image of both calves was obtained using gamma camera. Rectangular regions of interest were symmetrically drawn over both calves. The total count in the resting calf was subtracted from the total count in the exercising calf, and the percentage of the increase, termed perfusion reserve, was determined. The percentage of increase in the total count(Ct) in the exercising right calf was calculated according to the following formula: perfusion reserve (%) = (Ct in the exercising calf – Ct in the resting calf) ÷ (Ct in the resting calf) × 100%
Results: Significant difference was found between the perfusion reserves of RA patients and control group (30.7 ± 22.6 and 48.3 ± 27.2, respectively, P=0.015).The negative correlation between perfusion .The negative correlation between the perfusion reserve and the duration of the disease was mildly significant P=0.05.The negative correlation between the perfusion reserve and DAS was not statistically significant where P=0.064.
Conclusion: In conclusion, determination of the perfusion reserve in the lower limb muscles of RA patients using Tc-99MIBI is useful in detecting premature atherosclerosis in such patients.
Keywords:
• Rheumatoid arthritis
• Perfusion reserve
• Technetium sestaMIBI muscle perfusion scan
• Atherosclerosis