Session Type: Abstract Submissions (ACR)
Structural destruction in peripheral joints may occur over time in both PsA and RA. We previously reported that 47% of early PsA patients treated with DMARD developed erosions within 24 months of disease onset. Digital X-ray radiogrammetry (DXR) is a sensitive method for quantifying changes in cortical bone mineral density (DXR-BMD) in the early phase of the disease. Radiological assessment using conventional X-rays is essential as an outcome measure to evaluate treatment efficacy.
The aim of this study was (1) to investigate radiographic changes in early PsA and RA prior to and 3, 12 months after introducing an anti-rheumatic drug; (2) to explore associations between radiographic assessment and DXR-BMD; and (3) to study if DXR-BMD measurements are predictive for radiographic progression over 12 months in patients treated with a DMARD or in combination with a TNFi.
Recent-onset (<12 months), active, treatment naïve PsA and RA patients were selected. Hand X-rays were obtained at 0, 3 and 12 months and read by a radiologist blinded for the study. Sharp-van der Heijde modified scoring method for PsA was used. Erosion (ES) and joint space narrowing scores (JSNS) were calculated. X-rays from PsA patients were also scored for proliferation (PS) according to the Ratigen Score. DXR-BMD was measured on the same X-rays scored for joint damage. Mean DXR-BMD (mg/cm2) values of both hands and changes in DXR-BMD (mg/cm2/month) were calculated. Regression analysis was used to assess predictors for radiographic progression from baseline to 12 months.
64 patients (32 PsA, 32 RA) were included. 95% were commenced on DMARD at baseline and 11.7 % (12.5% RA; 10.7% PsA) were also started on a TNFi. At 12 months 94.8% of the patients were on DMARD and 34.5% on TNFi (33.3 % RA; 35.7% PsA).
53% of RA and 66% of PsA patients had normal X-rays at baseline; 53% and 61% at 12 months respectively. Erosions were present in 41% of RA and 22% of PsA patients at baseline; 40% and 25% at 12 months.
There was no significant difference in mTSS between RA and PsA, but mTSS was higher in PsA at 12 months compared to baseline and 3 months (p=0.05). There was little radiographic progression over 1 year in both groups (2 RA and 4 PsA patients). ES and mTSS were higher, JSNS was lower in RA compared to PsA at all time points.
Inverse correlations were observed approaching significance between mTSS and DXR-BMD at all time points in PsA and in the entire cohort at 3 and 12 months. Changes in DXR-BMD from 3 to 12 months correlated significantly with baseline mTSS in both groups (RA r=-0.37, p=0.04; PsA r=-0.45, p=0.02) and in the entire cohort (r=-0.34, p=0.01).
Linear regression analyses indicated that high DXR-BMD at baseline associated with lower mTSS (β=18.26, p=0.03) in PsA and with JSNS and mTSS (β=5.68, p=0.04; β=9.17, p=0.04) in the entire group at 12 months. Change in DXR-BMD over 12 months associated significantly with ES, JSNS and mTSS at 3 and 12 months in the entire group.
To our knowledge this is the first prospective study showing correlations between DXR-BMD and radiographic damage in PsA in the early phase of the disease. Hand DXR-BMD correlated with subsequent radiographic damage in patients with PsA.
E. J. Heffernan,
Pfizer, Abbott, BMS, MSD, Roche, UCB,
Pfizer, Abbott, BMS, MSD, Janssen, Roche ,
Pfizer, Abbott, Janssen, Roche, UCB ,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cortical-bone-density-as-measured-by-digital-x-ray-radiogrammetry-correlates-with-radiographic-joint-damage-in-the-hands-within-1-year-in-psoriatic-arthritis/