Bone Mineral Density Loss in Clinically Suspect Arthralgia Is Associated with Subclinical Inflammation and Progression to Clinical Arthritis

L. Mangnus¹, H.W. van Steenbergen², M. Reijnierse³, J. Kälvesten^4,5,6 and A.H.M. van der Helm-van Mil², ¹Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ²Leiden University Medical Center, Leiden, Netherlands, ³Radiology, Leiden University Medical Center, Leiden, Netherlands, ⁴Radiology, Faculty of Health Sciences, Linköping, Sweden, ⁵Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden, ⁶Sectra AB, Linköping, Sweden

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Bone density, Inflammation, magnetic resonance imaging (MRI) and rheumatoid arthritis (RA)

Session Information

Date: Sunday, November 13, 2016

Title: Imaging of Rheumatic Diseases - Poster I: Ultrasound and Emerging Technologies

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Peripheral bone mineral density (BMD) can be decreased in early rheumatoid arthritis but it is unknown if BMD loss emerges already before arthritis is clinically apparent. We aimed to study if BMD loss occurs in patients with clinically suspect arthralgia (CSA), if it is associated with progression to clinical arthritis and if it is associated with MRI-detected subclinical inflammation.

Methods: Patients with CSA had arthralgia for <1 year and were suspect to progress to RA according to their rheumatologists. At baseline a 1.5T MRI was performed of unilateral MCP, wrist and MTP-joints and scored on synovitis, bone marrow edema and tenosynovitis;. summing these features yielded the MRI-inflammation score. Digital X-ray radiogrammetry (DXR) was used to measure BMD on two sequential conventional hand radiographs (mean interval between radiographs 4.4 months). The change in BMD was studied; BMD loss was defined as decrease of ≥2.5 mg/cm²/month. Patients were followed on arthritis development for median 18.4 months.

Results: In CSA-patients (n=108) change in BMD was negatively associated with age (β=-0.03, p=0.007). Within CSA-patients BMD loss was associated with arthritis development (adjusted for age HR=6.1, 95%CI=1.7;21.4) and was most frequently measured in the months before clinical arthritis development. The MRI-inflammation scores were associated with the change in BMD (adjusted for age β=-0.05, p=0.047). The MRI-inflammation score and BMD loss were both independently associated with arthritis development (HR=1.1 95%CI=1.1;1.2 and HR=4.6 95%CI=1.2;17.2 respectively).

Conclusion: In CSA-patients BMD loss is associated with MRI-detectable subclinical inflammation and with progression to clinical arthritis.

Disclosure: L. Mangnus, None; H. W. van Steenbergen, None; M. Reijnierse, None; J. Kälvesten, Employee of Sectra AB, 3; A. H. M. van der Helm-van Mil, None.

To cite this abstract in AMA style:

Mangnus L, van Steenbergen HW, Reijnierse M, Kälvesten J, van der Helm-van Mil AHM. Bone Mineral Density Loss in Clinically Suspect Arthralgia Is Associated with Subclinical Inflammation and Progression to Clinical Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/bone-mineral-density-loss-in-clinically-suspect-arthralgia-is-associated-with-subclinical-inflammation-and-progression-to-clinical-arthritis/. Accessed .

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