Does Evaluation Of Hand Bone Loss By Digital x-Ray Radiogrammetry Within The First 3 Months After Diagnosis Of Rheumatoid Arthrits Identify Patients At Risk For Radiological Progression?

Ewa H. Berglin¹ and Solbritt M. Rantapaa-Dahlqvist², ¹Rheumatology, Institution of Public health and clinical medicine/ Rheumatology, University of Umeå, Umeå, Sweden, ²Rheumatology, Institution of Public health and clinical medicine/ Rheumatology, University of Umeå, Umeå, Sweden, Umea, Sweden

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Digital X-ray Radiogrammetry (DXR) and Early Rheumatoid Arthritis

Session Information

Title: Imaging in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

To evaluate the usefulness of assement of hand bone loss in prediction of radiological progression in patients with early rheumatoid arthritis (RA).

Methods:

Patients with early RA (< 12 months of symptoms) were consequtively included in the study and treated according to the Swedish guidelines. Hand bone mineral density (BMD) was measured with digital x-ray radiogrammetry (DXR) at inclusion and after 3 months and the difference between the two assessments was related to clinical measurements and to the radiological outcome (Larsen score) at one year follow-up.

Results:

Sixty-eight patients (71% females) with disease duration of (mean (SD)) 5.28 (2.79) months were included. The BMD decreased significantly for the whole cohort from (mean, (SD)) 0.571(0.0918) to 0.567 (0.0933) g/cm²(P = 0.0001). Seventeen percent of the patients had a decrease of > 2.50 mg/cm²/month which was regarded as considerable bone loss (CBL). The level of C-reactive protein (CRP) at inclusion was significantly higher among patients with CBL compared with patients with less bone loss (P=0.007). Female patients with DAS28 above 2.6 at 3 months had significantly higher rate of bone loss (mean (SD) 1.745 (1.715) vs 0.667 (1.530) mg/cm²,P = 0.038) and a significantly higher increase in Larsen score between inclusion and 1 year mean (SD) 0.94 (1.211) vs 2.08 (2.060), P = 0.029 than female patients with DAS28< 2.6. Mean value (SD) of Larsen score at inclusion was 5.5 (5.53) and 7.1 (6.00) at 1 year (P < 0.0001). There was a tendency, although not statistically significant, of greater difference in Larsen score between inclusion and 1 year in patients with CBL compared with patients with less bone loss (data not shown).

Conclusion: Hand bone loss was significant already at 3 months after diagnosis of RA. It was related to measures of inflammation and with a trend suggesting a relationship with radiological progression

Disclosure:

E. H. Berglin,
None;

S. M. Rantapaa-Dahlqvist,
None.

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