Periarticular uptake of 99mtechnetium diphosphonate in psoriatics: correlation with cutaneous activity

The periarticular uptake of 99mtechnetium-labeled diphosphonate (99mTcDp) was compared in 12 patients hospitalized for psoriasis and in 12 hospitalized for other dermatoses not associated with arthropathy. The 12 patients with psoriasis had recent onset disease of less than 5 years duration; neither group had historical or clinical evidence of arthritis. All psoriatics had markedly abnormal scans with symmetrically increased periarticular uptake about the imaged joints. None of the controls had similar findings. In 4 patients scanned with 99mtechnetium-pertechnetate within 24 hours of their 99mTcDP scan, no evidence of inflammatory synovitis was found. Three of these patients were serially imaged with 99mTcDP at intervals of 2 weeks to 3 months after their initial study, when obvious clinical improvement in their psoriasis was apparent. Improvement in the radionuclide joint images was demonstrated in some of the patients, but none reverted to normal during the study period. In light of recent evidence for the preferential binding of 99mTcDP to immature collagen, it is suggested that psoriasis may represent a generalized, but uncharacterized, collagen disorder present in bone as well as skin, linking the cutaneous disease with the potential for arthropathy.