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

Abstract

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.

Evaluation of hand bone loss by digital X-ray radiogrammetry as a complement to clinical and radiographic assessment in early rheumatoid arthritis: results from the SWEFOT trial

“…We show that HBL over the first 12 months, measured by DXR is a predictor for radiographic progression at 24 months as well as between 12 and 24 months. This is in agreement with previous studies [9,10,13,27]. Less HBL was observed in patients who had a good clinical response to MTX after 3 months.…”

“…However we agree with Forslind et al [13] that DXR may have a role in predicting destructive rheumatoid arthritis in clinical praxis where/when the radiographs cannot be analyzed according to the scoring systems used in trials.…”

“…The sensitivity of conventional radiography regarding osteopenia is limited, as it can only be detected if the reduction of bone density is more than 35–50% [7,8]. In recent years, studies have been presented on an alternative method for ascertaining inflammation-related osteopenia in patients with RA, measuring BMD in the diaphyses of the 2 nd , 3 rd and 4 th metacarpal bone on conventional radiographs of the hands by digital X-ray radiogrammetry (DXR) [5,9-13]. DXR is a computerized version of the earlier technique of radiogrammetry, measuring cortical bone thickness as originally proposed by Barnett and Nordin [14].…”

“…DXR is a computerized version of the earlier technique of radiogrammetry, measuring cortical bone thickness as originally proposed by Barnett and Nordin [14]. Prior studies have suggested that this new technique has predictive value for RA-related joint damages and radiological progression [7,9,12,13,15]. Here, we present data on hand BMD change measured by DXR based on part of the SWEFOT (SWEdish PharmacOTherapy) early RA trial population [16].…”

Polyarthrite rhumatoïde

“…Cependant, la PR est une maladie très hétérogène dont l'évolution est extrêmement variable d'un patient à l'autre . La radiogrammétrie numérisée à rayons X pourrait identifier les patients à risque de dégradation structurale mais elle reste encore du domaine de la recherche [125,127,161,172,375] . À l'opposé, la PR peut être bénigne avec pas ou peu de lésions radiographiques et de gêne fonctionnelle, même après 10 ans d'évolution (20-30 % des cas) .…”