Abstract
Summary
The bone mineral density (BMD) measurement of the hand in rheumatoid arthritis (RA) patients is no standard measurement method as yet. The aim was to contribute to the standardization of the hand BMD measurement, especially of periarticular regions. As results, we found best precision values for the wrist and a significant correlation between hand and spine/femur BMD depending on disease activity and disease duration.
Introduction
This study was conducted to investigate (i) the precision of periarticular hand BMD measuring, (ii) the periarticular demineralization of the hand, (iii) the correlation between periarticular hand BMD and spine/femur BMD, and (iv) the correlation of hand BMD to hand synovitis.
Methods
A number of 52 RA patients were examined by BMD measurement of the femoral neck, spine, whole hand, metacarpophalangeal (MCP) joints II–V, personal identity profile (PIP) joints II–V, and wrist using dual-energy X-ray absorptiometry (DXA). Synovitis of the hand was examined by ultrasonography and magnetic resonance imaging (MRI). Three subgroups were further analyzed: early RA, established RA with moderate and with high disease activity. Early RA and established RA patients with high disease activity were Followed up after 12 months.
Results
We found (1) best precision of BMD measurement for the wrist, (2) BMD in RA significantly reduced if compared to normal controls, (3) a highly significant positive correlation between hand and spine/femur BMD and the power of correlation to depend on disease activity and disease duration (high correlation in RA with moderate disease activity and early RA, very high correlation in RA with high disease activity), (4) a negative correlation between hand BMD and hand synovitis in RA with high disease activity, and (5) a significant reduction of synovitis but no change in hand BMD after 12 months, respectively.
Conclusions
This study shows a highly significant correlation between hand BMD and spine/femur BMD in RA patients depending on disease activity and disease duration. We conclude to measure BMD at different sites including hands in order to quantify bone loss in RA patients most properly.
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References
Alenfeld FE, Diessel E, Brezger M et al (2000) Detailed analyses of periarticular osteoporosis in rheumatoid arthritis. Osteoporos Int 11(5):400–407
Haugenberg G, Lodder MC, Lems WF et al (2004) Hand cortical bone mass and its association with radiographic joint damage and fractures in 50–70 year old female patients with rheumatoid arthritis: cross sectional Oslo-Truro-Amsterdam (OSTRA) collaborative study. Ann Rheum Dis 63:1331–1334
Deodhar AA, Brabyn J, Pande I et al (2003) Hand bone densitometry in rheumatoid arthritis, a five year longitudinal study: an outcome measure and a prognostic marker. Ann Rheum Dis 62:767–770
Devlin J, Lilley J, Gough A et al (1996) Clinical association of dual-energy X-ray absorptiometry measurement of hand bone mass in rheumatoid arthritis. Br J Rheumatol 35:1256–1262
Harrison BJ, Hutchinson CE, Adams J et al (2002) Assessing periarticular bone mineral density in patients with early psoriatic arthritis or rheumatoid arthritis. Ann Rheum Dis 61:1007–1011
Deodhar AA, Brabyn J, Jones PW et al (1995) Longitudinal study of hand bone densitometry in rheumatoid arthritis. Arthritis Rheum 38:1204–1210
Böttcher J, Pfeil A, Heinrich B et al (2005) Digital radiogrammetry as a new diagnostic tool for estimation of disease-related osteoporosis in rheumatoid arthritis compared with pQCT. Rheumatol Int 25(6):457–464
Jensen T, Hansen M, Jensen KE et al (2005) Comparison of dual X-ray absorptiometry (DXA), digital X-ray radiogrammetry (DXR), and conventional radiographs in the evaluation of osteoporosis and bone erosions in patients with rheumatoid arthritis. Scand J Rheumatol 34(1):27–33
Böttcher J, Pfeil A, Rosholm A (2006) Computerized digital imaging techniques provided by digital X-ray radiogrammetry as new diagnostic tool in rheumatoid arthritis. J Digit Imaging 19(3):279–288
Sturtridge W, Lentle B, Hanley DA (1996) Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada: 2. The use of bone density measurement in the diagnosis and management of osteoporosis. CMAJ 155(7):924–929
Wakefield RJ, Kong KO, Conaghan PG et al (2003) The role of ultrasonography and magnetic resonance imaging in early rheumatoid arthritis. Clin Exp Rheumatol 21(5 Suppl 31):S42–S49
Keen HI, Brown AK, Wakefield RJ et al (2005) MRI and musculoskeletal ultrasonography as diagnostic tools in early arthritis. Rheum Dis Clin North Am 31(4):699–714
Scheel AK, Hermann KG, Kahler E et al (2005) A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthritis Rheum 52(3):733–743
Murphy E, Bresnihan B, FitzGerald O (2008) Measurement of periarticular bone mineral density in the hands of patients with early inflammatory arthritis using dual energy X-ray absorptiometry. Clin Rheumatol 27(6):763–766
Harrison BJ, Hutchinson CE, Adams J et al (2002) Assessing periarticular bone mineral density in patients with early psoriatic arthritis or rheumatoid arthritis. Ann Rheum Dis 61(11):1007–1111
Gluer CC, Blake G, Lu Y et al (1995) Accurate assessment of precision errors: how to measure the reproducibility of bone densitometry techniques. Osteoporos Int 5(4):262–270
Lodder MC, Lems WF, Ader HJ (2004) Reproducibility of bone mineral density measurement in daily practice. Ann Rheum Dis 63(3):285–289
Pfeil A, Haugeberg G, Hansch A et al (2011) The value of digital X-ray radiogrammetry in the assessment of inflammatory bone loss in rheumatoid arthritis. Arthritis Care Res (Hoboken) 63(5):666–674
Castañeda S, González-Alvaro I, Rodríguez-Salvanés F et al (2007) Reproducibility of metacarpophalangeal bone mass measurements obtained by dual-energy X-ray absorptiometry in healthy volunteers and patients with early arthritis. J Clin Densitom 10(3):298–305
Jensen T, Klarlund M, Hansen M et al (2004) Bone loss in unclassified polyarthritis and early rheumatoid arthritis is better detected by digital x ray radiogrammetry than dual x ray absorptiometry: relationship with disease activity and radiographic outcome. Ann Rheum Dis 63(1):15–22
Haugeberg G, Emery P (2005) Value of dual-energy X-ray absorptiometry as a diagnostic and assessment tool in early rheumatoid arthritis. Rheum Dis Clin North Am 31(4):715–728
Hill CL, Schultz CG, Wu R et al (2010) Measurement of hand bone mineral density in early rheumatoid arthritis using dual energy X-ray absorptiometry. Int J Rheum Dis 13(3):230–234
Bejarano V, Hensor E, Green M, Haugeberg G, Brown AK, Buch MH, Emery P, Conaghan PG (2011) Arthritis Care Res (Hoboken) doi:10.1002/acr.20553. [Epub ahead of print]
Desai SP, Gravallese EM, Shadick NA et al (2010) Hand bone mineral density is associated with both total hip and lumbar spine bone mineral density in post-menopausal women with RA. Rheumatology (Oxford) 49(3):513–519
Böttcher J, Pfeil A, Mentzel H, Kramer A, Schäfer ML, Lehmann G, Eidner T, Petrovitch A, Malich A, Hein G, Kaiser WA (2006) Peripheral bone status in rheumatoid arthritis evaluated by digital X-ray radiogrammetry and compared with multisite quantitative ultrasound. Calcif Tissue Int 78(1):25–34
Ozgocmen S, Kiris A, Kocakoc E et al (2004) Evaluation of metacarpophalangeal joint synovitis in rheumatoid arthritis by power Doppler technique: relationship between synovial vascularization and periarticular bone mineral density. Joint Bone Spine 71(5):384–388
Böttcher J, Pfeil A, Rosholm A (2005) Digital X-ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: a cross-sectional and longitudinal study. Arthritis Rheum 52(12):3850–3859
Haugeberg G, Green MJ, Quinn MA et al (2006) Hand bone loss in early undifferentiated arthritis: evaluating bone mineral density loss before the development of rheumatoid arthritis. Ann Rheum Dis 65(6):736–740
Güler-Yüksel M, Allaart CF, Goekoop-Ruiterman YPM (2009) Changes in hand and generalised bone mineral density in patients with recent-onset rheumatoid arthritis. Ann Rheum Dis 68:330–336
Berglin E, Lorentzon R, Nordmark L et al (2003) Predictors of radiological progression and changes in hand bone density in early rheumatoid arthritis. Rheumatology (Oxford) 42(2):268–275
Bolotin HH (1998) A new perspective on the causal influence of soft tissue composition on DXA-measured in vivo bone mineral density. J Bone Miner Res 13(11):1739–1746
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This study was supported by a grant from GE Healthcare, Germany.
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Naumann, L., Hermann, KG.A., Huscher, D. et al. Quantification of periarticular demineralization and synovialitis of the hand in rheumatoid arthritis patients. Osteoporos Int 23, 2671–2679 (2012). https://doi.org/10.1007/s00198-012-1897-x
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DOI: https://doi.org/10.1007/s00198-012-1897-x