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Comparison of bone structure and microstructure in the metacarpal heads between patients with psoriatic arthritis and healthy controls: an HR-pQCT study

Abstract

Summary

Human cadaveric study has indicated that the metacarpal head (MCH) is intracapsular in location. We hypothesized that exposure to the intra-articular inflammatory milieu in psoriatic arthritis (PsA) will lead to bone loss in the MCH.

Introduction

To compare the bone structure and microstructure in the MCH between patients with PsA and healthy controls by high-resolution peripheral quantitative CT (HR-pQCT), and to ascertain factors associated with bone loss in PsA patients.

Methods

Sixty-two PsA patients without joint destruction and 62 age-, gender-, and body mass index–matched healthy subjects underwent HR-pQCT imaging of the second and third MCH (MCH 2&3). The number and volume of bone erosion and enthesiophytes, as well as volumetric bone mineral density (vBMD) and microstructure at the MCH 2&3, were recorded. Correlation analysis and multivariable linear regression models were used to determine the association of demographic and disease-specific variables with compromised bone structure and microstructure in PsA.

Results

At the MCH 2&3, bone erosion (p = 0.003) and enthesiophyte (p = 0.000) volumes in PsA patients were significantly larger than healthy controls. In PsA patients, older age was associated with a larger erosion and enthesiophyte volume. Concerning the mean vBMD and microstructure at the MCH 2&3, PsA patients had significantly lower mean vBMD (average vBMD − 6.9%, trabecular vBMD − 8.8%, peri-trabecular vBMD − 7.7%, meta-trabecular vBMD − 9.8%), trabecular bone volume fraction (− 8.8%), and trabecular thickness (− 8.1%) compared with control subjects. Multivariable regression analysis revealed that older age and a higher C-reactive protein level were associated with trabecular bone loss.

Conclusions

PsA patients had a higher burden of bone damages (erosions and enthesiophytes) and trabecular bone loss compared with healthy control at the MCH. Inflammation contributed to the deterioration in trabecular microstructure in these patients.

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References

  1. 1.

    Moll JM, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3:55–78

  2. 2.

    Gladman DD, Antoni C, Mease P, Clegg DO, Nash P (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64 Suppl 2:ii14–ii17

  3. 3.

    Ritchlin CT, Colbert RA, Gladman DD (2017) Psoriatic arthritis. N Engl J Med 376:957–970

  4. 4.

    Finzel S, Englbrecht M, Engelke K, Stach C, Schett G (2011) A comparative study of periarticular bone lesions in rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis 70:122–127

  5. 5.

    Finzel S, Sahinbegovic E, Kocijan R, Engelke K, Englbrecht M, Schett G (2014) Inflammatory bone spur formation in psoriatic arthritis is different from bone spur formation in hand osteoarthritis. Arthritis Rheum 66:2968–2975

  6. 6.

    Geusens P, Chapurlat R, Schett G, Ghasem-Zadeh A, Seeman E, de Jong J, van den Bergh J (2014) High-resolution in vivo imaging of bone and joints: a window to microarchitecture. Nat Rev Rheumatol 10:304–313

  7. 7.

    Simon D, Faustini F, Kleyer A, Haschka J, Englbrecht M, Kraus S, Hueber AJ, Kocijan R, Sticherling M, Schett G, Rech J (2016) Analysis of periarticular bone changes in patients with cutaneous psoriasis without associated psoriatic arthritis. Ann Rheum Dis 75:660–666

  8. 8.

    Simon D, Kleyer A, Faustini F et al (2018) Simultaneous quantification of bone erosions and enthesiophytes in the joints of patients with psoriasis or psoriatic arthritis - effects of age and disease duration. Arthritis Res Ther 20:203

  9. 9.

    Finzel S, Kraus S, Schmidt S, Hueber A, Rech J, Engelke K, Englbrecht M, Schett G (2013) Bone anabolic changes progress in psoriatic arthritis patients despite treatment with methotrexate or tumour necrosis factor inhibitors. Ann Rheum Dis 72:1176–1181

  10. 10.

    Kampylafka E, d’Oliveira I, Linz C et al (2018) Resolution of synovitis and arrest of catabolic and anabolic bone changes in patients with psoriatic arthritis by IL-17A blockade with secukinumab: results from the prospective PSARTROS study. Arthritis Res Ther 20:153

  11. 11.

    Simon D, Kleyer A, Stemmler F et al (2017) Age- and sex-dependent changes of intra-articular cortical and trabecular bone structure and the effects of rheumatoid arthritis. J Bone Miner Res 32:722–730

  12. 12.

    Zhu TY, Griffith JF, Qin L, Hung VW, Fong TN, Au SK, Kwok AW, Leung PC, Li EK, Tam LS (2015) Density, structure, and strength of the distal radius in patients with psoriatic arthritis: the role of inflammation and cardiovascular risk factors. Osteoporos Int 26:261–272

  13. 13.

    Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, Group CS (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673

  14. 14.

    Stach CM, Bauerle M, Englbrecht M, Kronke G, Engelke K, Manger B, Schett G (2010) Periarticular bone structure in rheumatoid arthritis patients and healthy individuals assessed by high-resolution computed tomography. Arthritis Rheum 62:330–339

  15. 15.

    Aletaha D, Alasti F, Smolen JS (2017) Disease activity states of the DAPSA, a psoriatic arthritis specific instrument, are valid against functional status and structural progression. Ann Rheum Dis 76:418–421

  16. 16.

    Scharmga A, Peters M, van den Bergh JP, Geusens P, Loeffen D, van Rietbergen B, Schoonbrood T, Vosse D, Weijers R, van Tubergen A (2018) Development of a scoring method to visually score cortical interruptions on high-resolution peripheral quantitative computed tomography in rheumatoid arthritis and healthy controls. PLoS One 13:e0200331

  17. 17.

    Scharmga A, Peters M, van Tubergen A, van den Bergh J, Barnabe C, Finzel S, van Rietbergen B, Geusens P (2016) Heterogeneity of cortical breaks in hand joints of patients with rheumatoid arthritis and healthy controls imaged by high-resolution peripheral quantitative computed tomography. J Rheumatol 43:1914–1920

  18. 18.

    Boutroy S, Chapurlat R, Vanden-Bossche A, Locrelle H, Thomas T, Marotte H (2015) Erosion or vascular channel? Arthritis Rheum 67:2956

  19. 19.

    Scharmga A, Keller KK, Peters M, van Tubergen A, van den Bergh JP, van Rietbergen B, Weijers R, Loeffen D, Hauge EM, Geusens P (2017) Vascular channels in metacarpophalangeal joints: a comparative histologic and high-resolution imaging study. Sci Rep 7:8966

  20. 20.

    Finzel S, Ohrndorf S, Englbrecht M, Stach C, Messerschmidt J, Schett G, Backhaus M (2011) A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions. Arthritis Rheum 63:1231–1236

  21. 21.

    Faustini F, Simon D, Oliveira I, Kleyer A, Haschka J, Englbrecht M, Cavalcante AR, Kraus S, Tabosa TP, Figueiredo C, Hueber AJ, Kocijan R, Cavallaro A, Schett G, Sticherling M, Rech J (2016) Subclinical joint inflammation in patients with psoriasis without concomitant psoriatic arthritis: a cross-sectional and longitudinal analysis. Ann Rheum Dis 75:2068–2074

  22. 22.

    Yushkevich PA, Yang G, Gerig G (2016) ITK-SNAP: an interactive tool for semi-automatic segmentation of multi-modality biomedical images. Conference Proc 2016:3342–3345

  23. 23.

    Yushkevich PA, Gerig G (2017) ITK-SNAP: an intractive medical image segmentation tool to meet the need for expert-guided segmentation of complex medical images. IEEE Pulse 8:54–57

  24. 24.

    Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. NeuroImage 31:1116–1128

  25. 25.

    Vallaeys K, Kacem A, Legoux H, Le Tenier M, Hamitouche C, Arbab-Chirani R (2015) 3D dento-maxillary osteolytic lesion and active contour segmentation pilot study in CBCT: semi-automatic vs manual methods. Dento Maxillo Facial Radiol 44:20150079

  26. 26.

    Besson FL, Henry T, Meyer C et al (2018) Rapid contour-based segmentation for (18)F-FDG PET imaging of lung tumors by using ITK-SNAP: comparison to expert-based segmentation. Radiology 288:277–284

  27. 27.

    Akudjedu TN, Nabulsi L, Makelyte M et al (2018) A comparative study of segmentation techniques for the quantification of brain subcortical volume. Brain Imaging Behav 12:1678–1695

  28. 28.

    Lu P, Barazzetti L, Chandran V, Gavaghan K, Weber S, Gerber N, Reyes M (2018) Highly accurate facial nerve segmentation refinement from CBCT/CT imaging using a super-resolution classification approach. IEEE Trans Biomed Eng 65:178–188

  29. 29.

    Lories RJ, Schett G (2012) Pathophysiology of new bone formation and ankylosis in spondyloarthritis. Rheum Dis Clin N Am 38:555–567

  30. 30.

    Boutroy S, Bouxsein ML, Munoz F, Delmas PD (2005) In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab 90:6508–6515

  31. 31.

    Yang H, Yu A, Burghardt AJ, Virayavanich W, Link TM, Imboden JB, Li X (2017) Quantitative characterization of metacarpal and radial bone in rheumatoid arthritis using high resolution-peripheral quantitative computed tomography. Int J Rheum Dis 20:353–362

  32. 32.

    Zhu TY, Griffith JF, Qin L et al (2013) Structure and strength of the distal radius in female patients with rheumatoid arthritis: a case-control study. J Bone Miner Res 28:794–806

  33. 33.

    Simon D, Kleyer A, Englbrecht M, Stemmler F, Simon C, Berlin A, Kocijan R, Haschka J, Hirschmann S, Atreya R, Neurath MF, Sticherling M, Rech J, Hueber AJ, Engelke K, Schett G (2018) A comparative analysis of articular bone in large cohort of patients with chronic inflammatory diseases of the joints, the gut and the skin. Bone 116:87–93

  34. 34.

    Zhu TY, Griffith JF, Qin L, Hung VW, Fong TN, Kwok AW, Leung PC, Li EK, Tam LS (2012) Bone density and microarchitecture: relationship between hand, peripheral, and axial skeletal sites assessed by HR-pQCT and DXA in rheumatoid arthritis. Calcif Tissue Int 91:343–355

  35. 35.

    Kleyer A, Finzel S, Rech J, Manger B, Krieter M, Faustini F, Araujo E, Hueber AJ, Harre U, Engelke K, Schett G (2014) Bone loss before the clinical onset of rheumatoid arthritis in subjects with anticitrullinated protein antibodies. Ann Rheum Dis 73:854–860

  36. 36.

    Fouque-Aubert A, Boutroy S, Marotte H, Vilayphiou N, Bacchetta J, Miossec P, Delmas PD, Chapurlat RD (2010) Assessment of hand bone loss in rheumatoid arthritis by high-resolution peripheral quantitative CT. Ann Rheum Dis 69:1671–1676

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Acknowledgments

We thank all patients who participated in this study.

Author information

Correspondence to L.-S. Tam.

Ethics declarations

Ethics approval (CRE-2012.082) was obtained from the Ethics Committee of The Chinese University of Hong Kong-New Territories East Cluster Hospitals with written informed consent obtained from all participants.

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None.

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Wu, D., Griffith, J., Lam, S. et al. Comparison of bone structure and microstructure in the metacarpal heads between patients with psoriatic arthritis and healthy controls: an HR-pQCT study. Osteoporos Int (2020). https://doi.org/10.1007/s00198-020-05298-z

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Keywords

  • Bone erosion
  • Enthesiophyte
  • HR-pQCT
  • Psoriatic arthritis