Session Information
Date: Monday, November 9, 2015
Title: Imaging of Rheumatic Diseases Poster II: X-ray, MRI, PET and CT
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Rheumatoid arthritis (RA) is characterised by progressive joint destruction and loss of periarticular bone mass. Thus hand bone loss (HBL) has been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and gender-related bone loss is lacking. We aimed to establish a HBL reference material and investigate whether HBL normalises in RA patients during tumour necrosis factor inhibitor (TNFα-I) treatment in clinical practice.
Methods: Hand bone mass (DXR-BMD) was assessed by Digital X-ray Radiogrammetry (DXR), a computerised method of estimating cortical bone mineral density in the 2nd – 4thmetacarpal bone, in a reference population and a patient cohort. The reference population was 1,487/ 2,541 randomly selected men/women who had hand x-rays done in the cross-sectional Copenhagen Osteoarthritis Study. Linear regression analyses were fitted to the data and mean age-related changes in DXR-BMD (ie. normal HBL) estimated for men and women.
The patient cohort comprised 135 patients in the DANBIO registry with hand x-rays obtained ~2 years prior to TNFα-I (pre-baseline, patients treated with conventional synthethic Disease-Modifying Anti-Rheumatic Drugs (csDMARD)), at start of TNFα-I (baseline) and ~ 2 years after TNFα-I start (follow-up). Annual HBL during csDMARD and TNFα-I treatment were calculated in the individual patients and compared with the lower 95% CI of normal HBL for the matching age and gender to assess if increased HBL was present.
Results: Table 1 presents the HBL reference material. The 135 RA patients (85% women, 71% IgM-RF positive, median age 55(range 23-84) years; median disease duration 5(range 1-53) years) had a median pre-baseline DAS28 of 4.3(range 1.6-6.9) and a baseline DAS28 of 5.3(1.4-8.2). TNFα-I treatment was infliximab (74%), etanercept (13%) or adalimumab (13%). At follow-up (DAS28 3.1(1.4-7.7) 59% received the initial TNFα-I, 27% had switched to another biological drug and 14% had withdrawn.
Compared to the reference population, 101 (75%) patients had increased HBL during csDMARD treatment while 79 (59%) patients had increased HBL during TNFα-I treatment (p = 0.17,Chi-Sq). In 38 patients with increased HBL during csDMARD treatment HBL was normalised during TNF-I. Sixteen patients had normal HBL during csDMARD treatment but increased HBL during treatment with TNFα-I.
Conclusion: We have established a reference material for HBL in the general population. Increased HBL was present in the majority of RA patients initiating TNFα-I treatment in clinical practice and was normalised in few patients during treatment.
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Table 1 Age-related changes of DXR-BMD in 2,541 Danish women and 1,485 Danish men |
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|
Women |
Absolute 1 year change
|
Men |
Absolute 1 year change
|
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|
Age (years) |
N |
BMD (g/cm2), mean (SD) |
Estimated hand bone loss (g/cm2) (95 % CI) |
N |
BMD (g/cm2), mean (SD) |
Estimated hand bone loss (g/cm2) (95 % CI) |
|
18-29 |
41 |
0.597 (0.05) |
0.00416 (0.00268 – 0.00564) |
32 |
0.666 (0.06) |
-0.00012 (-0.00095 – 0.00071) |
|
30-34 |
51 |
0.599 (0.04) |
0.00123 (0.00031 – 0.00213) |
35 |
0.671 (0.06) |
-0.00060 (-0.00128 – 0.00007) |
|
35-39 |
84 |
0.601 (0.05) |
– 0.00066 (-0.00122 – -0.00009) |
45 |
0.679 (0.05) |
-0.00098 (-0.00153 – -0.00042) |
|
40-44 |
116 |
0.589 (0.04) |
– 0.00224 (-0.00260 – -0.00189) |
71 |
0.660 (0.05) |
-0.00135 (-0.00179- -0.00090) |
|
45-49 |
131 |
0.592 (0.05) |
-0.00351 (-0.00379 – -0.00323) |
98 |
0.668 (0.05) |
-0.00172 (-0.00206 – -0.00138) |
|
50-54 |
185 |
0.569 (0.05) |
-0.00437 (-0.00470 – -0.00411) |
133 |
0.653 (0.05) |
-0.00202 (-0.00235 – -0.00184) |
|
55-59 |
322 |
0.541 (0.05) |
-0.00513 (-0.00543 – -0.00483) |
209 |
0.636 (0.05) |
-0.00247 (-0.00269 – -0.00225) |
|
60-64 |
311 |
0.513 (0.06) |
-0.00548 (-0.00575 – -0.00521) |
198 |
0.623 (0.06) |
-0.00284 (-0.00309- -0.00259) |
|
65-69 |
430 |
0.486 (0.06) |
-0.00552 (-0.00577 – -0.00527) |
211 |
0.602 (0.06) |
-0.00321 (-0.00354- -0.00288) |
|
70-74 |
394 |
0.460 (0.05) |
-0.00525 (-0.00559- -0.00492) |
213 |
0.594 (0.06) |
-0.00358 (-0.00401- -0.00316) |
|
75-79 |
307 |
0.440 (0.05) |
-0.00468 (-0.00525- -0.00410) |
140 |
0.572 (0.06) |
-0.00396 (-0.00450- -0.00342) |
|
80-84 |
123 |
0.411 (0.05) |
-0.00380 (-0.00472 – -0.00288) |
68 |
0.563 (0.06) |
-0.00432 (-0.00499- -0.00367) |
|
85-93 |
46 |
0.400 (0.06) |
-0.00261 (-0.00397- -0.00124) |
32 |
0.534 (0.08) |
-0.00470 (-0.00548- -0.00392) |
|
Total |
2541 |
0.505 (0.08) |
|
1485 |
0.619 (0.08) |
|
|
DXR: Digital X-ray Radiogrammetry; BMD: Bone Mineral Density; CI: Confidence Interval. |
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To cite this abstract in AMA style:
Ørnbjerg LM, Østergaard M, Jensen TD, Bach Mortensen P, Hyldstrup L, Boyesen P, Thormann A, Tarp U, Bøhme W, Lindegaard H, Poulsen UE, Hansen A, Schlemmer A, Graudal N, Andersen AR, Espesen J, Kollerup G, Glintborg B, Rintek Madsen O, Jensen DV, Lund Hetland M. Tumour Necrosis Factor Inhibitor Treatment Normalises Hand Bone Loss in a Minority of Rheumatoid Arthritis Patients Treated in Clinical Practice. Results from the Copenhagen Osteoarthritis Study and the Danbio Registry [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/tumour-necrosis-factor-inhibitor-treatment-normalises-hand-bone-loss-in-a-minority-of-rheumatoid-arthritis-patients-treated-in-clinical-practice-results-from-the-copenhagen-osteoarthritis-study/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/tumour-necrosis-factor-inhibitor-treatment-normalises-hand-bone-loss-in-a-minority-of-rheumatoid-arthritis-patients-treated-in-clinical-practice-results-from-the-copenhagen-osteoarthritis-study/