Does digital X-ray radiogrammetry have a role in identifying patients at increased risk for joint destruction in early rheumatoid arthritisReport as inadecuate

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Arthritis Research and Therapy

, 14:R219

First Online: 15 October 2012Received: 23 March 2012Revised: 31 August 2012Accepted: 25 September 2012


IntroductionThe aim of this study was to investigate the role of hand bone mineral density BMD loss analyzed with digital X-ray radiogrammetry DXR in early rheumatoid arthritis RA as a predictor for progression of joint damage.

MethodsIn 379 patients with early RA, baseline and one-year hand BMD was measured with DXR and the hand bone loss HBL was analyzed using the smallest detectable change HBLsdc and tertiles HBLtertiles. Joint damage in hands and feet were scored according to the Sharp van der Heijde SHS method at baseline and at one, two, five and eight years. At the same time-points Disease Activity Score DAS28 was calculated and functional disability assessed. Rheumatoid factor RF and antibodies against cyclic citrullinated peptides anti-CCP were analyzed at baseline.

ResultsSixty-six percent of the patients had hand BMD loss in the first year of RA determined by HBLsdc and 65% by HBLtertiles. Radiographic progression after two, five and eight years was associated with hand bone loss defined by HBLsdc. By HBLtertiles there were significant associations at all time-points except at eight years. The change in DXR at one year ChDXR1yr correlated significantly and inversely with the change in SHS ChSHS at two, five and eight years. Multivariate analysis showed that only change in SHS during the first year and the presence of anti-CCP were independent predictors of long-term progressive joint damage. If radiographic scores were not included, DXR-BMD loss was an independent predictor. Patients with great bone loss by HBLtertiles had significantly more often high disease activity after two years. However, neither bone loss by HBLsdc or HBLtertiles nor by ChDXR1yr was an independent predictor of remission after two, five and eight years.

ConclusionsThis study confirms previous reports of an association of decrease in DXR-BMD during the first disease year with progression of radiographic joint damage over an extended period of time. This association was independent in a regression model only when radiological findings were excluded suggesting a possible predictive role of DXR-BMD in clinical practice when radiographic evaluation is not available. However, further studies are required before this can be established.

AbbreviationsACRAmerican College of Rheumatology

Anti-CCPanti-cyclic citrullinated proteins

BARFOTBetter Anti-Rheumatic FarmacoTherapy

BMDbone mineral density

ChDXRchange in DXR

ChSHSchange in SHS

CRPC-reactive protein

DASDisease Activity Score

DXRdigital X-ray radiogrammetry


ESRerythrocyte sedimentation rate

EULAREuropean League against Rheumatism

GHgeneral health

HAQHealth Assessment Questionnaire

HBLhand bone loss

ICCintra-class correlation coefficient

JSNjoint space narrowing

PPVpositive predictive value

RArheumatoid arthritis

RFrheumatoid factor

sdcsmallest detectable change

SHSSharp van der Heijde Score

VASvisual analogue scale.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4058 contains supplementary material, which is available to authorized users.

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Author: Kristina Forslind - Johan Kälvesten - Ingiäld Hafström - Björn Svensson - for the BARFOT Study Group


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