RESEARCH - Hand bone densitometry: a more sensitive standard for the assessment of early bone damage in RA

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ls of the Rheumatic Diseases 2007;66:1513-1517

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EXTENDED REPORTS

Hand bone densitometry: a more sensitive standard for the assessment of

early bone damage in rheumatoid arthritis

Glenn Haugeberg 1,2, J Green 3, Philip G Conaghan 3, Mark Quinn 3,

Wakefield 3, na M Proudman 4, Sheena 3,

Hensor 3, Emery 3

1 Department of Rheumatology Sørlandet Hospital, Kristiansand, Norway

2 Norwegian University of Science and Technology (NTNU), Trondheim, Norway

3 Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK

4 Rheumatology Unit, Royal Adelaide Hospital, North Terrace Adelaide, 5000,

Australia

Objective: To examine the role of hand dual-energy x ray absorptiometry

(DEXA) compared with radiography in the assessment of bone involvement in

patients with early rheumatoid arthritis (RA) who have active disease.

Methods: The study population (n = 79) had RA of <12 months' duration and

were selected for poor prognostic features. Clinical data and bone mineral

density (BMD) data were collected at baseline, 24 and 48 weeks. Hand

radiographs were performed at baseline and 48 weeks. Bone damage analyses

were performed for the group and individuals using the smallest detectable

change (SDC) method.

Results: At baseline, mean disease duration was 8.5 months, erythrocyte

sedimentation rate was 34.3 mm/hour, C-reactive protein was 40.2 mg/l,

Health Assessment Questionnaire score was 1.35 and 81% of patients were

positive for rheumatoid factor. Mean (95% CI) hand BMD loss was 2.5% (-3.5

to -1.5) at 24 weeks and 2.6% (-3.8 to -1.5) at 48 weeks. Individual hand

bone loss exceeding the SDC was seen in 46.8% at 24 weeks and in 58.2% at 48

weeks. In the subgroup of 58 patients who had undergone radiography,

radiographic joint damage score evaluated by the Sharp-van der Heijde method

increased from 4.8 to 10.6 (p = 0.001). Individual hand bone loss in this

subgroup exceeding the SDC was seen in 50.0% at 24 weeks and in 56.9% at 48

weeks, whereas at 48 weeks only 22.4% had deteriorated in modified Sharp

score.

Conclusion: The study results indicate that hand DEXA is a more sensitive

tool than radiology (radiographic joint-damage scores), for measuring

disease-related bone damage in early RA.

http://ard.bmj.com/cgi/content/abstract/66/11/1513?etoc

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