Background/Purpose:   RA and PsA result in joint destruction and functional disability if left untreated. Although therapies for patients with RA and PsA are effective and well-tolerated, recent evidence highlighted poor adherence to these anti-rheumatic treatment. Various factors hamper the adherence of patients with (false) medical beliefs and lack of knowledge being the major obstacles. We therefore aim to develop tools that help patients to understand and experience the impact of joint disease. In this study, we used high resolution peripheral quantitative computed imaging (HR-pQCT) to develop a virtual 3D reconstruction of finger joints. We then investigated (i) the feasibility to generate exact 3D models of arthritic and healthy joints, and tested (ii) whether these prototypes are accepted by patients and helped them to better understand and experience their medical condition.

Methods:   HR-pQCT (Scanco) measurements were performed in healthy individuals and patients with erosive and non-erosive inflammatory joint disease. Then, a 3D printable file was generated and printed (objet30). Ten healthy participants (HC), 15 RA patients and 15 PsA patients, who were demonstrated printed healthy and arthritic joints, underwent a detailed, standardized interview to investigate if the “arthro-haptic” experience helped to improve their understanding of the disease. Ethical approval was obtained; all patients and HC consented for the study.

Results:   Utilizing HR-pQCT images of MCP heads, high quality and exact 3D models were created. For better visualization and haptic experience, bones were enlarged 3:1. The prototypes achieved a resolution as low as 24 μm. Erosions in different sizes as well as the trabecular network were visualized in detail, demonstrating a structural reduction in arthritic vs healthy bone. The erosions were mainly found at a region close beneath the cartilage area either radial/ulnar or dorsal. No erosions were identified at the palmar location. Artificial truncation separated the MCP head in 2 parts; the print showed a dorsal porous structured cortical defect with irregularly shaped borders, which normally could not be detected in plain X rays. In addition, a cystic structure which was also detected by MRI showed contrast enhancement and contained a new erosion at a two year follow up. After 3D demonstration (healthy vs. erosive joint, visually and haptically) HC and arthritis patients were asked for their emotional opinion. 26/39 (66%) were deeply affected, often quoting “shock”. 13/15 (86%) of the RA and 11/15 (73%) of the PsA patients stated, that they would rethink their attitude regarding medication adherence after being confronted with the 3D models. More importantly, 21/24 (87,5%) of RA and PsA patients expressed that they would have wished to see such 3D prints during their first disease specific conversations. 16/27 (59%) would appreciate seeing their own joint.

Conclusion: Using arthro-haptic 3D joints may help patients to better understand the impact of inflammatory arthritides on bone integrity and long-term damage. Additional studies need to prove that the better understanding will improve adherence of patients.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/from-3d-printed-bones-to-arthritis-patients-arthro-haptic-experience-supporting-disease-awareness/