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Periarticular osteoporosis of the forearm correlated with joint destruction and functional impairment in patients with rheumatoid arthritis

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Abstract

Summary

The relationship between periarticular osteoporosis in the distal forearm and joint destruction or functional impairment in patients with rheumatoid arthritis (RA) is not sufficiently elucidated. From a single institutional cohort study, we found a strong correlation between periarticular forearm bone mineral density (BMD) and joint destruction or functional impairment.

Introduction

This study was conducted to investigate (1) the difference between various periarticular regions of interest (ROIs) of BMD of the forearm, (2) the correlation between periarticular forearm BMD and joint destruction and physical function, (3) the independent variables for predicting BMD of the forearm, and (4) the forearm BMD of different ROIs in the early stage of RA.

Methods

We conducted a cross-sectional study in an RA cohort. Measurements included BMD of the distal forearm, joint destruction of the hands assessed by modified total Sharp score (mTSS), functional impairment assessed by a health assessment questionnaire (HAQ), and other clinical data. Variables affecting the forearm BMD values were analyzed by correlation and stepwise regression analyses.

Results

Of the 405 patients enrolled in the present study, 370 (average age; 62.9 years) were identified as having definite RA with a complete set of data. BMD in the distal end of the forearm (BMDud) was significantly reduced compared with that in the distal third of the forearm (BMD1/3). In a stepwise regression analysis, the mTSS in BMD1/3 was an independent predicting variable, while age and partial HAQ scores associated with the upper extremity were common independent variables in BMDud and BMD1/3. BMDud was significantly less than BMD1/3, even in patients with a short duration of the disease. BMD1/3 was significantly less in non-remission group compared with that in remission group in patients with a short duration of the disease.

Conclusion

Periarticular BMD in the distal forearm is closely correlated with joint destruction and functional impairment in RA. Periarticular BMD in the distal forearm may be already reduced at the clinical manifestation of the disease.

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Conflicts of interest

H.I. has received research grant and/or speaker fee from Chugai, Mitsubishi-Tanabe, Daiichi-Sankyo, Eisai, Bristol-Myers, Abbvie, and Astellas; M.F., M.H., M.I., and T.F. belongs to the department that is financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, Bristol-Myers, and Eisai). M.F. and M.I. have received grant and research support from Astellas and Pfizer Japan; M.F. has received grant and research support from Astellas; T.F. has received grant and research support from Bristol-Myers and Pfizer Japan.; T.I., N.Y., C.T., M.A., Y.H., T.M., H.A., and S.M. declared no conflict of interest exists. The sponsors were not involved in the study design; in the collection, analysis, interpretation of data; in the writing of this manuscript; or in the decision to submit the article for publication. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan

    T. Iwata, H. Ito, M. Furu, M. Ishikawa, M. Azukizawa, Y. Hamamoto & S. Matsuda

  2. Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan

    M. Furu, M. Hashimoto, T. Fujii & M. Ishikawa

  3. Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan

    N. Yamakawa & T. Mimori

  4. Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

    C. Terao

  5. Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan

    H. Akiyama

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  1. T. Iwata
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  2. H. Ito
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  3. M. Furu
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Corresponding author

Correspondence to H. Ito.

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Supplementary Fig. 1

Example of a dual-energy x-ray absorptiometry of the radius/ulna that was used to determine periarticular forearm bone mineral density. The automated evaluation software places various regions of interest in the ultradistal, mid-distal, one-third distal and total bone regions. BMD, bone mineral density; BMDud, BMD in the ultradistal region; BMDmid, BMD in the mid-distal region; BMD1/3, BMD in the one-third distal region (TIFF 1521 kb)

Supplementary Table 1

Correlations between various ROIs of forearm BMD (TIFF 1521 kb)

Supplementary Table 2

Univariate analysis of forearm BMD with related factors (n = 324) (TIFF 1521 kb)

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Iwata, T., Ito, H., Furu, M. et al. Periarticular osteoporosis of the forearm correlated with joint destruction and functional impairment in patients with rheumatoid arthritis. Osteoporos Int 27, 691–701 (2016). https://doi.org/10.1007/s00198-015-3256-1

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  • DOI: https://doi.org/10.1007/s00198-015-3256-1

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