Trabecular Bone Texture parameters are Correlated with Magnetic Resonance Imaging (MRI) bone Edema At Hand and Wrist in Active Rheumatoid Arthritis (RA)

Thao Pham¹, Sophie Trijau¹, Roland Chapurlat², Damien Loeuille³, Thierry Schaeverbeke⁴, Christian Roux⁵, Claude-Laurent Benhamou⁶, Olivier Vittecoq⁷, Jean Sibilia⁸, Frederic Mistretta⁹ and Cécile Hacquard-Bouder¹⁰, ¹Rheumatology Department, Sainte Marguerite Hospital, Marseille, France, ²Hôpital Edouard Herriot, Lyon, France, ³Rheumatology, CHU Brabois, Vandoeuvre les Nancy, France, ⁴Service de Rhumatologie, Groupe Hospitalier Pellegrin, Bordeaux, France, ⁵Rheumatology, Paris Descartes University, Paris, France, ⁶Centre Hospitalier Régional d'Orléans, Orleans, France, ⁷Rheumatology, Rouen University Hospital & Inserm905, University of Rouen, Rouen Cedex, France, ⁸Rheumatology, CHU Hautepierre, Strasbourg, France, ⁹Lyon, France, ¹⁰Abbott France, Rungis, France

Meeting: 2012 ACR/ARHP Annual Meeting

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

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects III: Infections/Risk Factors for Incident Rheumatoid Arthritis/Metrology/Classification/Biomarkers/Predictors of Rheumatolid Arthritis Activity & Severity

Session Type: Abstract Submissions (ACR)

Background/Purpose:

In RA, bone marrow edema (BME) is predictive of erosive progression. Bone erosions are assumed to appear through activation of local bone resorption mechanisms, reflected by periarticular osteopenia. Measurement of periarticular bone mineral density by DXA requires specific hand software limiting its application in large population, and does not assess bone texture. A new high resolution direct digital X-ray device has been recently developed to provide bone texture analysis reflecting changes in trabecular bone architecture, with a very low radiation exposure.

Objectives: To assess the correlation between MRI bone edema and trabecular bone texture parameters in active RA.

Methods:

Study design: cross-sectional multicenter study. Comparative MRI and high resolution X-rays of the dominant hand and wrist were obtained from 55 patients with active RA according to ACR/EULAR criteria (DAS 28 ≥ 3.2). Clinical examination and radiographs of the hands and feet were also performed. High resolution direct digital X-ray (BMA™, D3A Medical Systems): The fractal trabecular bone texture parameter (Hmean) was evaluated on the 2nd and 3^rd metacarpal head, capitatum and lunatum. MRI: BME was scored according to the RA MRI score (RAMRIS) by two independent and experienced radiologists (central reading). BME was also specifically assessed on the 4 bones where Hmean was evaluated (BME4 score). Radiographs: plain radiographs were scored using the modified Sharp-van der Heijde method. Analysis: Inter-reader reliability: ICC. Correlation between BME and Hmean:Spearman test.

Results:

Data from 53 patients were analyzable. The main patients characteristics were (mean ± SD): age 57 ± 14 years, 75% women, disease duration 8.6 ± 9.2 years, DAS28 5.4 ± 1.3, anti-CCP 76%, Sharp-DvdH 23.8 ± 31.3, currently treated with DMARDs 74%, biologics 47%, corticosteroids 60% (mean daily dosage 9.1 ± 6.6 mg). The mean ± SD [median] RAMRIS BME, BME4 and Hmean scores were 12.7 ± 14.6 [5.0], 2.7 ± 2.8 [1.0] and 0.60 ± 0.06 [0.61], respectively. RAMRIS BME inter-reader reliability: ICC=0.96. Correlations between Hmean and both RAMRIS BME and BME4 scores were r=-0.31 (p=0.022) and r=-0.32 (p=0.018), respectively. When evaluated only on the 2nd and 3^rd metacarpal head, Hmean was significantly correlated with the total BME score r=-0.28 (p=0.038) whereas it was not when evaluated on lunatum and capitatum (r=-0.22 – p=0.120).

Conclusion:

This study demonstrated trabecular bone texture parameters are correlated to MRI bone edema scores. It would be interesting to assess if bone texture impairment, measured with a high resolution digital Xray device, could predict RA radiographic progression in a wider range prospective study.

Disclosure:

T. Pham,