Using hand bone mass measurements to assess progression of rheumatoid arthritis

Haugeberg, Glenn

doi:10.1177/1759720x10362297

Cited by 6 publications

(7 citation statements)

References 84 publications

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“…In early RA, periarticular osteoporosis may occur before the erosions visible [16]. For this reason the relationship between hand or forearm bone loss and erosions can be expected and have also been shown in various studies [12,16,17]. Whereas in our study, this relationship was not only early but also in the late RA.…”

Section: Discussionsupporting

confidence: 85%

The relation between joint erosion and forearm bone mineral density in female patients with Rheumatoid Arthritis

Bozbaş¹,

Gürer²,

Şendur³

2018

Pau Med J

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Purpose: Rheumatoid arthritis (RA) is a disease that characterized by joint damage including periarticular osteoporosis and focal bone erosion. Despite the fact that periarticular osteoporosis and erosions are known as radiographic hallmarks of RA, there is a lack of data on the relationship between forearm bone loss and radiographic damage. For this reason, we aimed in this study to determine whether there is a relationship between focal erosions and OP in RA patients. Materials and methods: We evaluated 49 female patients with RA. Anteroposterior hand and foot radiographs and bone mineral density measurement of forearm, hip and lumbar spine with dual x-ray absorptiometry of all patients were taken at simultaneously. Radiographs were analyzed using the Larsen method. Disease activity was evaluated by DAS-28 and functional ability was measured with Health Assessment Questionnaire and Duruöz Hand Index. Results:Patients had the mean age 53.9±11.8 and an average disease duration of 7.9±5.9 years. The erosion score was correlated with bone mineral density of forearm, but not with lumbar spine and hip. The disease activity and functional ability were not correlated with Larsen score. Both osteoporosis in all evaluated area and correlations were not affected by the menopause status and disease duration. Conclusion: Our results demonstrated that bone mineral density of forearm indicate the erosion severity in female patients with RA.

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Section: Discussionsupporting

confidence: 85%

The relation between joint erosion and forearm bone mineral density in female patients with Rheumatoid Arthritis

Bozbaş¹,

Gürer²,

Şendur³

2018

Pau Med J

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“…Biological agents such as TNF‐alpha‐inhibitors were reported to arrest bone loss in RA . However, a specific benefit on prevention of osteoporosis or fractures has not yet been shown .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, disease‐modifying antirheumatic drugs (DMARDs) and biologic agents are established therapies for reducing RA joint damage and are widely used in daily clinical practice. Some of these were reported to arrest bone loss or even to increase bone mineral density . However, their influence on bone microstructure and geometry in humans remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, general risk factors, such as low vitamin D level, postmenopausal state, and immobilization further exacerbate bone disease in patients with RA . Together, these factors result in rapid loss of bone mass at periarticular and nonperiarticular sites including the femoral head and the spine . In addition, RA is considered an independent risk factor for secondary osteoporosis and osteoporosis‐related vertebral and nonvertebral fractures, which is also reflected by its inclusion into the fracture risk assessment tool (FRAX) …”

Section: Introductionmentioning

confidence: 99%

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Decreased Quantity and Quality of the Periarticular and Nonperiarticular Bone in Patients With Rheumatoid Arthritis: A Cross-Sectional HR-pQCT Study

Kocijan

Finzel

Englbrecht

et al. 2013

Journal of Bone and Mineral Research

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Rheumatoid arthritis (RA) is a highly bone destructive disease. Although it is well established that RA leads to bone loss and increased fracture risk, current knowledge on the microstructural changes of bone in RA is still limited. The purpose of this study was to assess the microstructure of periarticular and nonperiarticular bone in female and male RA patients and compare it with respective healthy controls. We performed two high-resolution peripheral quantitative computed tomography (HR-pQCT; Xtreme-CT) scans, one of the distal radius and one of the ultradistal radius in 90 patients with RA (60 females, 30 males) and 70 healthy controls (40 females, 30 males) matched for sex, age, and body mass index. Volumetric bone mineral density (vBMD), bone geometry, and bone microstructure including trabecular bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), cortical thickness (Ct.Th) and cortical porosity (Ct.Po) were assessed. At the distal and ultradistal radius, trabecular (p ¼ 0.005 and p < 0.001) and cortical BMD (p < 0.001 and p < 0.001) were significantly decreased in male and female patients with RA, respectively. BV/TV was also decreased at both sites, based on lower Tb.N in female RA (p < 0.001 for both sites) and lower Tb.Th (p ¼ 0.034 and p ¼ 0.005) in male RA patients compared with respective healthy controls. Cortical thinning (p ¼ 0.018 and p ¼ 0.002) but not Ct.Po (p ¼ 0.070 and p ¼ 0.275) was pronounced in male and female RA patients at the distal radius. Cortical perimeter was increased in male and female RA patients at both sites. Multiple regression models showed that bone geometry (cortical perimeter) is predominantly influenced by age of the RA patient, cortical thickness by both age and disease duration, and trabecular microstructure predominantly by the disease duration. In summary, these data show profound deterioration of bone microstructure in the appendicular skeleton of RA patients at both periarticular and nonperiarticular sites.

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“…Periarticular bone loss and osteitis coincide early in RA and AS and not only precede but also predict the occurrence of visible erosions [ 76 ]. This raises the question of the mechanism by which these anatomical coincident changes in the joints, entheses, and bone marrow occur.…”

Section: Discussion and Summarymentioning

confidence: 99%

Osteoimmunology and osteoporosis

2011

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The concept of osteoimmunology is based on growing insight into the links between the immune system and bone at the anatomical, vascular, cellular, and molecular levels. In both rheumatoid arthritis (RA) and ankylosing spondylitis (AS), bone is a target of inflammation. Activated immune cells at sites of inflammation produce a wide spectrum of cytokines in favor of increased bone resorption in RA and AS, resulting in bone erosions, osteitis, and peri-inflammatory and systemic bone loss. Peri-inflammatory bone formation is impaired in RA, resulting in non-healing of erosions, and this allows a local vicious circle of inflammation between synovitis, osteitis, and local bone loss. In contrast, peri-inflammatory bone formation is increased in AS, resulting in healing of erosions, ossifying enthesitis, and potential ankylosis of sacroiliac joints and intervertebral connections, and this changes the biomechanical competence of the spine. These changes in bone remodeling and structure contribute to the increased risk of vertebral fractures (in RA and AS) and non-vertebral fractures (in RA), and this risk is related to severity of disease and is independent of and superimposed on background fracture risk. Identifying patients who have RA and AS and are at high fracture risk and considering fracture prevention are, therefore, advocated in guidelines. Local peri-inflammatory bone loss and osteitis occur early and precede and predict erosive bone destruction in RA and AS and syndesmophytes in AS, which can occur despite clinically detectable inflammation (the so-called 'disconnection'). With the availability of new techniques to evaluate peri-inflammatory bone loss, osteitis, and erosions, peri-inflammatory bone changes are an exciting field for further research in the context of osteoimmunology.

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Using hand bone mass measurements to assess progression of rheumatoid arthritis

Cited by 6 publications

References 84 publications

The relation between joint erosion and forearm bone mineral density in female patients with Rheumatoid Arthritis

The relation between joint erosion and forearm bone mineral density in female patients with Rheumatoid Arthritis

Decreased Quantity and Quality of the Periarticular and Nonperiarticular Bone in Patients With Rheumatoid Arthritis: A Cross-Sectional HR-pQCT Study

Osteoimmunology and osteoporosis

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