Evidence of subclinical intestinal inflammation by (99m)technetium leukocyte scintigraphy in patients with HLA-B27 positive juvenile onset active spondyloarthropathy

Objective. The concept that gut inflammation is implicated in the pathogene sis of spondyloarthropathies (SpA) has long been considered. Subclinical in testinal inflammation has been reported in adult patients with SpA by histo logical examination of intestinal biopsies. We assessed the presence of gut inflammation by abdominal Tc-99m-hexamethyl propylene amine oxime (Tc-99m- HMPAO) labeled leukocyte scintigraphy in a group of children and adolescent s with HLA-B27 positive SpA without gastrointestinal (GI) symptoms, and cor related the scintigraphic results to disease activity. Methods, Abdominal scintigraphy with 99mTc-HMPAO labeled leukocytes was per formed in 27 HLA-B27 positive children and adolescents with SpA without CI symptoms. Patients were divided into 2 groups according to the presence of active or inactive joint disease: Group A, 17 patients with active disease, and Group B, 10 patients with inactive disease. Patients with positive abd ominal scintigraphy underwent complete bowel investigation by means of smal l bowel barium follow-through, abdominal ultrasound scan, and ileocolonosco py with mucosal biopsies. Results. Thirteen of 27 patients (48%) had scintigraphy indicating the pres ence of bowel inflammation. All patients with abnormal scan had active join t disease, whereas no patient with inactive disease had a positive intestin al uptake of labeled leukocytes, Bowel investigation revealed the presence of aspecific mucosal inflammatory changes in the majority of patients with positive scintigraphy. Conclusion, The presence of intestinal leukocyte uptake only in patients wi th active joint disease, even if intestinal inflammatory changes were minim al and clinical gut manifestations were absent, supports the role of gut in flammation in the pathogenesis of joint disease in HLA-B27 positive patient s with SpA.