A comparison of bone loss in early and late rheumatoid arthritis using quantitative phalangeal ultrasound

Abstract

This study compares amplitude-dependent speed of sound (AD-SoS) measured by phalangeal ultrasonography in a group of 60 patients with early rheumatoid arthritis (RA) with those who had had the disease for more than 4 years. The mean duration of the early disease group was 1.4 years, and the mean of the established RA group was 14.6 years. Plasma viscosity (PV), C-reactive protein (CRP) and HAQ scores were obtained. Forty-nine patients with early RA had hand radiographs assessed by the Larsen score method. The DBM Sonic system was assessed on normal volunteers and a coefficient of variation of 0.88% obtained. A significant correlation was found between the left and right hands of the patients groups studied ( r=0.84). The mean Z score of both hands was therefore used in comparing the two clinical groups. Results showed no correlation between CRP, PV and Z scores of AD-SoS. The HAQ scores showed a weak negative correlation, and there was no correlation between the Larsen score and Z score, or the number of swollen joints and Z score. However, the early and established groups with RA were significantly different (#E5/E5#=0.004). Within the early RA group the Z score for AD-SoS was lower in those with disease duration of less than 2 years (-1.71) than in those with disease duration of 2-4 years (-1.01). This suggests that bone loss in the fingers is greater in the first 2 years of disease than in the following 2 years, which might reflect an effect of treatment.

Clinical utilities of quantitative ultrasound in osteoporosis associated with inflammatory rheumatic diseases

“…In 60 patients with RA, a significant reduction was detected in the Z scores with increased disease duration (−1.52 vs. −2.12, P=0.004), and the Z score for AD-SoS was lower in those with disease duration of less than 2 years (−1.71) than in those with disease duration of 2-4 years (−1.01) (78). A similar positive association between the severity of QUS osteoporosis at the calcaneus and symptom duration was reported in a larger sample (n=256) (79).…”

“…In a number of studies, RA patients using the finger ultrasound technique also failed to show a correlation between Z scores and disease activity markers such as ESR or CRP (71,78,84). Finger ultrasound was moderately correlated with measures of hand function, with correlation coefficients of 0.37 and 0.39 for health assessment questionnaires and grip strength (71).…”