Hand bone densitometry in rheumatoid arthritis, a five year longitudinal study: an outcome measure and a prognostic marker

Deodhar, A.; Brabyn, J; Pande, Ira; Scott, David; Woolf, Anthony D.

doi:10.1136/ard.62.8.767

Cited by 59 publications

(52 citation statements)

References 10 publications

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“…Hand BMD loss in RA is reported to precede radiographic joint damage (3)(4)(5) and has been observed in early stages of RA and in undifferentiated arthritis that later progressed to RA (6,7).…”

Section: Introductionmentioning

confidence: 99%

Changes in hand bone mineral density and the association with the level of disease activity in patients with rheumatoid arthritis: Bone mineral density measurements in a multicenter randomized clinical trial

Dirven

Güler‐Yüksel

Beus

et al. 2011

Arthritis Care & Research

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Objective. To determine if metacarpal bone mineral density (mBMD) gain occurs in patients with rheumatoid arthritis (RA). If mBMD loss is driven by inflammation, we expect to find mBMD gain in patients who are in remission. Methods. mBMD was measured by digital x-ray radiogrammetry in consecutive radiographs of 145 patients with RA with either continuous high disease activity (HDA; Disease Activity Score [DAS] >2.4), low disease activity (LDA; 1.6 > DAS < 2.4), or continuous clinical remission (CR; DAS <1.6) during a 1-year observation period. The association of mBMD changes with disease activity was investigated with multinomial regression analysis. Next, clinical variables associated with mBMD gain were identified. Results. Mean change in mBMD in CR patients was ؊0.03%, compared to ؊3.13% and ؊2.03% in HDA and LDA patients, respectively (overall, P < 0.001). Of the patients in CR, 32% had mBMD loss (less than or equal to ؊4.6 mg/cm 2 /year), compared to 62% and 66% of the patients with HDA or LDA, respectively, whereas 26% of the patients in CR had mBMD gain (>4.6 mg/cm 2 /year), compared to 2% of the patients with HDA and 5% of the patients with LDA. Patients in CR had a higher chance of having mBMD gain, compared with LDA and HDA (relative risk [RR] 14.9, 95% confidence interval [95% CI] 3.0 -18.7 and RR 4.7, 95% CI 1.2-6.3, respectively). CR, hormone replacement therapy, and lower age were significant independent predictors of mBMD gain. Conclusion. In RA, mBMD gain occurs primarily in patients in continuous (>1 year) CR and rarely in patients with continuous HDA or LDA. This suggests that mBMD loss is driven by inflammation.

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Section: Introductionmentioning

confidence: 99%

Changes in hand bone mineral density and the association with the level of disease activity in patients with rheumatoid arthritis: Bone mineral density measurements in a multicenter randomized clinical trial

Dirven

Güler‐Yüksel

Beus

et al. 2011

Arthritis Care & Research

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“…While it has been documented that radiogrammetry performs better than DXA when detecting hand bone loss in RA (11), this study did not include a comparison of these techniques. Deodhar et al reported a group of 40 patients with early RA who were followed up for 5 years with serial radiographs and DXA (12). They found no association between bone loss in the first 6 months and final Larsen radiographic score; however, patients with high bone loss at 6 months had a worse functional status as assessed by the Duruoz Hand Index compared to those with low bone loss.…”

Section: Discussionmentioning

confidence: 99%

Relationship between early bone mineral density changes and long‐term function and radiographic progression in rheumatoid arthritis

Bejarano¹,

Hensor²,

Green³

et al. 2011

Arthritis Care & Research

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Objective. To ascertain whether bone mineral density loss during the first year of treatment for early rheumatoid arthritis (RA) as assessed by dual x-ray absorptiometry (DXA) is associated with long-term function, quality of life, and radiographic progression. Methods. Early RA patients, prior to commencing disease-modifying antirheumatic drug therapy, underwent evaluation with DXA scans of both hands, femoral neck, and lumbar spine at the time of diagnosis, then at 1 year and final followup at >6 years. Clinical and laboratory data and hands and feet radiographs were obtained at baseline and final followup. Results. Sixty-four patients were assessed. At baseline, median disease duration was 6 months, mean 28-joint Disease Activity Score was 5.85, and median Health Assessment Questionnaire score was 1.38. Median followup was 6.4 years (range 5.1-7.2 years). For erosion scores, 86% of patients with hand bone density loss above the smallest detectable change after 1 year progressed versus 55% of those with no hand bone density loss (P ‫؍‬ 0.006). However, baseline radiographs showed a similar strength of association. Eighty-four percent of patients with erosions at baseline had erosion progression versus 57% of those with no baseline erosions (P ‫؍‬ 0.021). Additionally, first-year bone density loss was not associated with function and quality of life status at followup. Conclusion. Hand bone loss during the first year of treatment in early RA, as assessed with DXA, was associated with a high likelihood of radiographic progression; however, in the current study this was not superior to baseline radiographs. Furthermore, it was not associated with patient-reported outcomes.

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“…El bileği hariç tutularak, ön kol pozisyonerine parmaklar ekstansiyon pozisyonunda yerleştiri-lerek ve çekim el bileği distalinden başlayarak falanksların tamamını içine alacak şekilde yapılmıştır (21). Tüm ölçümler aynı teknisyen tarafından yapılmıştır, deneyimli bir rehabilitasyon uzmanı tarafından da tüm ölçümler değerlendirilmiştir.…”

Section: Gereç Ve Yöntemlerunclassified

Hand Bone Mineral Density in Hemiplegia and Their Clinical Corelation

Öncü¹,

Begoglu²,

Durlanik³

et al. 2014

Turk J Phys Med Rehab

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Objective: The aim of this study was to evaluate the hand bone mineral density (BMD) measurements and to assess the relationship between demographic and clinical parameters. Material and Methods:The study included 119 (46 women, 63 men) hemiplegic patients. Brunnstrom stage of the upper extremity and Modified Ashworth scale was used, for the evaluation of motor function and spasticity. The level of functional independence in patients were evaluated with the functional independence measure (FIM). Hand dual energy x-ray absorptiometry (DEXA; Lunar Prodigy Advance, Lunar Corp., USA) for the assessment of bone mineral density of both hands were used. Results: In the entire group (p<0.01) and women (p<0.01) and in males (p<0.05) the paretic hand BMD values were significantly lower than the non-paretic side. Non-paretic hand BMD in women, were significantly lower than men (p<0.05). BMD on the hemiplegic hand was correlated with the hand and upper extremity spasticity severity (p<0.05), Brunnstrom stage (p<0.01), age in women (p<0.05) and FIM score (p<0.01). There were no statistically significant correlation between hand BMD and disease duration. Regression analysis revealed that the strongest predictors of BMD of the hemiplegic side were Brunnstrom stage (OR=4.701, p=0.001), FIM (OR=4.022, p=0.001) and women age (OR=1.220, p=0.050), respectively. Conclusion: To avoid an increase in fractures and associated morbidity due to a decrease in BMD of the upper extremity; the improvement in motor paresis and spasticity and functional independence, should take place in neurological rehabilitation program. Key Words: Bone mineral density, hemiplegic hand, functional activity Özet Amaç: Bu çalışmadaki amacımız, inmeli hastalarda paretik ve sağlam üst ekstremitede el kemik mineral yoğunluğunu (KMY) değerlendirmek ve KMY ölçümleri ile demografik ve klinik parametreler arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntemler: Çalışmaya 119 (56 kadın, 63 erkek) tek taraflı inme hastası alınmıştır. Üst ekstremitenin ve elin motor değerlendirmesinde Brunnstrom evrelemesi, spastisite değerlendirmesinde Modifiye Ashworth skalası kullanılmıştır. Hastaların fonksiyonel bağımsızlık düzeyi fonksiyonel bağımsızlık ölçeği (FBÖ) ile değerlendirilmiştir. Her iki el KMY ölçümlerinin değerlendirilmesinde Dual-Enerji X-ray absorbsiyometri (DEXA; Lunar Prodigy Advance, Lunar Corp., ABD) kullanılmıştır. Bulgular: Grubun tamamında (p<0,01), kadınlarda (p<0,01) ve erkeklerde (p<0,05) paretik taraftaki el KMY değerleri sağlam taraftan istatistiksel olarak anlamlı derecede daha düşüktü. Sağlam tarafta KMY değerleri kadınlarda, erkeklerden istatistiksel olarak anlamlı derecede daha düşüktü (p<0,05). Hemiplejik taraftaki el KMY değerleri ile üst ekstremite ve el spastisite şiddeti (p<0,05), Brunnstrom evresi (p<0,01), kadınlarda yaş (p<0,05) ve FBÖ skoru (p<0,01) arasında istatistiksel olarak anlamlı ilişki saptanırken; hastalık süresi arasında anlamlı ilişki saptanmadı. Hemiplejik taraftaki el KMY değerlerinin en güçlü belirleyicileri regresyon ana...

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Hand bone densitometry in rheumatoid arthritis, a five year longitudinal study: an outcome measure and a prognostic marker

Cited by 59 publications

References 10 publications

Changes in hand bone mineral density and the association with the level of disease activity in patients with rheumatoid arthritis: Bone mineral density measurements in a multicenter randomized clinical trial

Changes in hand bone mineral density and the association with the level of disease activity in patients with rheumatoid arthritis: Bone mineral density measurements in a multicenter randomized clinical trial

Relationship between early bone mineral density changes and long‐term function and radiographic progression in rheumatoid arthritis

Hand Bone Mineral Density in Hemiplegia and Their Clinical Corelation

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