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SHIN-TSU CHANG, CHIH-HUNG KU, and SHIOU-CHI CHERNG

ABSTRACT.

Objective. Poststreptococcal reactive arthritis (PSReA) is a nonsuppurative sequela of antecedent streptococcal infection, and can be investigated when detecting the anti-streptolysin O (ASO) titer. The relationship between ASO titer and involvement of the peripheral synovial joints has been examined in PSRA, but data are sparse for the sacroiliac (SI) joint. Quantitative SI joint scintigraphy has been used clinically to detect active SI joint disorders, but not for PSReA.

Methods. A total of 84 subjects were recruited; mean age at enrollment was 23 years (range 18.0–36.4 yrs). All subjects were examined for ASO titer levels (range 25–520 IU/ml) and SI joint imaging, determined by sacroiliac to sacrum (SI/S) ratio derived from SI scintigraphy.

Results. Most of the subjects with high ASO titer had unclassified or undifferentiated arthritis. Good correlation between the ASO titer and the SI/S ratio was determined statistically using Pearson correlation coefficients. The relationships between ASO titer and SI/S ratio at various locations (laterality: left, right; location of part: upper, middle, lower) were found to be significantly correlated using generalized estimating equations. After adjustment for potential confounders, a highly significant association was determined between ASO titer and SI/S ratio (p < 0.0001), with an increase of 1 IU/ml of titer resulting in a significant increase in SI/S ratio by 0.0008 units. Age was significantly associated with SI/S ratio (p = 0.0022), with each extra year increasing the ratio by 0.0074.

Conclusion. Our findings demonstrate a high correlation between SI joint involvement and high ASO titers. Subjects with SI joint involvement should be advised to have an ASO titer examination and quantitative SI joint scintigraphy. (First Release July 1 2007; J Rheumatol 2007;34:1746-52)

Key Indexing Terms:

SCINTIGRAPHY
BIOLOGICAL MARKERS
EVIDENCE-BASED MEDICINE
IMMUNOGLOBULINS
ARTHRITIS

From the Department of Physical Medicine and Rehabilitation and Department of Nuclear Medicine, Tri-Service General Hospital, Medical School, and School of Public Health, National Defense Medical Center, Taipei, Taiwan.

Supported in part by grants 91-2314-B016096 and 92-2314-B016019 from the National Science Council, Taiwan.

S-T. Chang, MD, MS, PhD, Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Medical School, National Defense Medical Center; C-H. Ku, PhD, School of Public Health, National Defense Medical Center; S-C. Cherng, MD, MS, Department of Nuclear Medicine, Tri-Service General Hospital.

Address reprint requests to Dr. S-T. Chang, Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, No. 325, Sec. 2, Cheng-Kong Road, Neihu District, Taipei 114, Taiwan. E-mail: stchang@ms87.url.com.tw

Accepted for publication April 28, 2007.