Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study

Boer, K.V.C. Wevers-de; Heimans, L.; Visser, Karen; Kälvesten, Johan; Goekoop, R.J.; Oosterhout, M. van; Harbers, J.B.; Bijkerk, C.; Steup-Beekman, M; Buck, Michelle; Sonnaville, Peter B J de; Huizinga, Tom W J; Allaart, Cornelia F

doi:10.1136/annrheumdis-2013-203749

Cited by 24 publications

(19 citation statements)

References 29 publications

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“…Results Based on 576 joints of 96 patients with eRA, a significant reduction from baseline to 1 year was observed in the JSW from 1.69 (±0. 19) mm to 1.66 (±0. 19) mm (p<0.01), and BMD from 0.583 (±0.068) g/cm 2 to 0.566 (±0.074) g/cm 2 (p<0.01).…”

Section: Introductionmentioning

confidence: 95%

“…19) mm to 1.66 (±0. 19) mm (p<0.01), and BMD from 0.583 (±0.068) g/cm 2 to 0.566 (±0.074) g/cm 2 (p<0.01). A significant positive association was observed between ΔJSW and ΔBMD over 1 year (p<0.0001).…”

Section: Introductionmentioning

confidence: 95%

“…16 17 Rapid loss of BMD is predictive of radiographic progression, 17 18 and this has been shown already after 4 months. 19 Using the SWEdish FarmacOTherapy (SWEFOT) study data of patients with early RA, we now investigate how JSW compares with JSN and explore the association between BMD and JSW using a multilevel mixed model, which has not previously been done. We also discuss the utility of these new tools in clinical practice.…”

Section: Rmd Openmentioning

confidence: 99%

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Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

et al. 2017

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ObjectivesTo study fully automated digital joint space width (JSW) and bone mineral density (BMD) in relation to a conventional radiographic scoring method in early rheumatoid arthritis (eRA).MethodsRadiographs scored by the modified Sharp van der Heijde score (SHS) in patients with eRA were acquired from the SWEdish FarmacOTherapy study. Fully automated JSW measurements of bilateral metacarpals 2, 3 and 4 were compared with the joint space narrowing (JSN) score in SHS. Multilevel mixed model statistics were applied to calculate the significance of the association between ΔJSW and ΔBMD over 1 year, and the JSW differences between damaged and undamaged joints as evaluated by the JSN.ResultsBased on 576 joints of 96 patients with eRA, a significant reduction from baseline to 1 year was observed in the JSW from 1.69 (±0.19) mm to 1.66 (±0.19) mm (p<0.01), and BMD from 0.583 (±0.068) g/cm2 to 0.566 (±0.074) g/cm2 (p<0.01). A significant positive association was observed between ΔJSW and ΔBMD over 1 year (p<0.0001). On an individual joint level, JSWs of undamaged (JSN=0) joints were wider than damaged (JSN>0) joints: 1.68 mm (95% CI 1.70 to 1.67) vs 1.54 mm (95% CI 1.63 to 1.46). Similarly the unadjusted multilevel model showed significant differences in JSW between undamaged (1.68 mm (95% CI 1.72 to 1.64)) and damaged joints (1.63 mm (95% CI 1.68 to 1.58)) (p=0.0048). This difference remained significant in the adjusted model: 1.66 mm (95% CI 1.70 to 1.61) vs 1.62 mm (95% CI 1.68 to 1.56) (p=0.042).ConclusionsTo measure the JSW with this fully automated digital tool may be useful as a quick and observer-independent application for evaluating cartilage damage in eRA.Trial registration numberNCT00764725.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 95%

Section: Rmd Openmentioning

confidence: 99%

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Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

et al. 2017

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“…Hinsichtlich des longitudinalen Verlaufes einer RA wurde im ersten Erkrankungsjahr die deutlichste Abnahme der DXR-BMD ( − 10,7 %, p < 0,05) anhand der Metakarpalia verifiziert [24]. Dabei ist der Knochenmineraldichteverlust der Metakarpalknochen bei einer frühren RA ein unabhängiger Prädikator (odds ratio = 1,5) bezüglich des Auftretens von Erosionen nach einem Jahr Erkrankungsdauer [25]. LEMERADIX-Studie erfolgte der Vergleich der DXR-Parameter zum etablierten Sharp-Score über einen Zeitraum von 22 Monaten im Mittel.…”

Section: Abstract ▼unclassified

Die Knochenmasse der Hand als Indikator für die strukturelle Destruktion bei Patienten mit einer rheumatoiden Arthritis – welche Messmethoden sind geeignet?

et al. 2014

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Schlüsselwörter • ▶ Rheumatoide Arthritis • ▶ digitale Radiogrammetrie • ▶ Dual Energy X-ray Absorp tiometry • ▶ hochauflösende periphere quantitative Computertomografie • ▶ Knochenmineraldichte Key words • ▶ rheumatoid arthritis • ▶ digital X-ray radiogrammetry • ▶ dual energy X-ray absorptiometry • ▶ high resolution peripheral quantitative computed tomography • ▶ bone mineral density Institute Die Institutsangaben sind am Ende des Beitrags gelistet Zusammenfassung ▼ Die rheumatoide Arthritis (RA) ist als chronisch entzündliche Erkrankung mit einer periartikulä-ren Demineralisation als krankheitsspezifisches Stigma gekennzeichnet. Hierbei ist eine hohe Krankheitsaktivität und eine entzündliche Manifestation an den peripheren Gelenkpartitionen mit einem periartikulären Knochenmasseverlust assoziiert. Die periartikuläre Demineralisation ist demzufolge mit der strukturellen Destruktion der RA-spezifisch involvierten Gelenke verbunden und ein Prädiktor für das Auftreten von Erosionen. Eine Bestimmung der periartikulären Demineralisation ist insbesondere durch die Digitale Radiogrammetrie (DXR), die Dual Energie X-ray Absorptiometry (DXA) und die hochauflö-sende periphere quantitative Computertomografie (HR-pQCT) quantifizierbar. Aufgrund einer verminderten Differenzierbarkeit zwischen der krankheitsspezifischen frühzeitigen periartikulären Demineralisation und einer systemischen sekundären Osteoporose als Spätfolge der RA kann anhand der aktuellen Daten eine Knochenmineraldichtemessung mittels DXA nicht favorisiert werden. Mittels DXR und HR-pQCT gelingt hingegen eine Bestimmung der Knochenmineraldichte an den Metakarpalknochen und im Bereich der Metakarpophalangealgelenke mit einer hohen Reproduzierbarkeit. Die exzellente Reproduzierbarkeit der DXR und der HR-pQCT ist die Vorraussetzung für eine präzise Quantifizierung der periartikulären Knochenmineraldichte mit der Möglichkeit einer Detektion von Therapieeffekten während der Behandlung einer RA. Abstract ▼Rheumatoid arthritis (RA) as a chronic inflammatory disease is typically characterised by the periarticular demineralisation. Advanced disease activity with involvement of various peripheral articulations is associated with decreased periarticular bone mass. The periarticular demineralisation functions as surrogate marker of structural destruction of the inflamed joints and is a predictor for the occurrence of erosions. Digital X-ray radiogrammetry (DXR), dual energy X-ray absorptiometry (DXA) and high-resolution quantitative computed tomography (HR-pQCT) were used for the quantification of periarticular demineralisation. Because of the low discriminative power with limited differentiation between early periarticular bone loss and prolonged systemic secondary osteoporosis, DXA measurements were not favourable for the measurement of hand bone loss. Otherwise, DXR and HR-pQCT present high reproducibility in the quantification of bone mineral density at the metacarpal bones and adjacent to metacarpophalangeal joints. The excellent reproducibility of the DXR and HR-...

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“…Paper I and other studies indicate that effect sizes from about 6 mg/cm²/month and down are common. Studies with down to 4 months follow up time have been published with a significant effect measured with DXR-BMD [45].…”

Section: Answers To Research Questionsmentioning

confidence: 99%

Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis

Kälvesten

2015

Linköping University Medical Dissertations

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Low-energy trauma and fragility fractures represent a major public health problem. The societal cost of the fragility fractures that occurred in Sweden 2010 has been estimated at €4 billion.In rheumatoid arthritis (RA), patient outcomes have improved greatly in recent years. However, the therapeutic decision making is still hampered by a lack of effective validated biomarkers. The cost of RA in Sweden 2010 has been estimated at €600 million, of which biologic drugs was €180 million.Digital X-ray radiogrammetry (DXR) is a method to measure bone mineral density (BMD) in the metacarpals of the hand. It can be applied opportunistically in several workflows where a person is already at an X-ray machine, including fracture repositioning follow up, mammography screening and hand imaging in RA. This thesis explored DXR-BMD as a marker to identify individuals who would benefit from anti-osteoporotic treatment, change rate of DXR-BMD as a biomarker in RA and under what conditions historical X-ray images can be used to estimate DXR-BMD. An automated method for measurement of joint space width in metacarpophalangeal and interphalangeal joints was also developed and evaluated as a biomarker in RA.Low DXR-BMD was predictive for hip fractures and predicted fragility fractures to a comparable degree as other BMD measurement sites. Rapid decrease of DXR-BMD was a strong and independent predictor for progression of radiographic damage in RA when manual radiographic progression scores were not available. Change of metacarpal joint space width was a statistically significant but weak predictor of joint space narrowing score progression. Guidelines and considerations for use of historical X-ray radiographs for DXR-BMD measurements in clinical trials have been developed and published. Populärvetenskaplig sammanfattningBenskörhetsrelaterade frakturer är ett stort hälsoproblem och en stor samhällsekonomisk belastning i Sverige. Den ekonomiska kostnaden enbart för de benskörhetsrelaterade frakturer som inträffade i Sverige under 2010 har uppskattats till 14 miljarder kronor om man exkluderar de negativa hälsoeffekterna för de personer som drabbas och 39 miljarder kronor om man räknar med förlust av kvalitetsjusterade levnadsår.Även reumatoid artrit (RA) är en sjukdom med stora hälsomässiga och ekonomiska konsekvenser. Stora framsteg i behandlingen av sjukdomen har gjorts under de senaste årtiondena och nydebuterade patienter idag har betydligt lägre risk för handikapp än för 20 år sedan. Trots framstegen så försvåras fortfarande det kliniska beslutsfattandet av begränsningar med de biomarkörer som finns tillgängliga vid klinikerna. Kostnaden för RA i Sverige 2010 har uppskattats till 5,6 miljarder kronor varav knappt en tredjedel utgjordes av biologiska läkemedel.Automatiserad digital röntgenradiogrammetri (DXR) är en metod att mäta innehållet av benmineral i skelettet (BMD) i handen. Då metoden baseras på en enkel handröntgen kan man tänka sig flera vårdflöden där metoden kan appliceras opportunistiskt när en patient redan stå...

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Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study

Abstract: In early RA patients, metacarpal BMD loss after 4 months of treatment is an independent predictor of radiological progression after 1 year. In patients without baseline erosions, early metacarpal BMD loss is the main predictor of radiological progression.

Cited by 24 publications

References 29 publications

Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

Die Knochenmasse der Hand als Indikator für die strukturelle Destruktion bei Patienten mit einer rheumatoiden Arthritis – welche Messmethoden sind geeignet?

Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis

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