Association of Bone Erosions and Osteophytes With Systemic Bone Involvement on High‐Resolution Peripheral Quantitative Computed Tomography in Premenopausal Women With Longstanding Rheumatoid Arthritis

Abstract

To evaluate premenopausal women with longstanding rheumatoid arthritis (RA) for potential associations between parameters of localized bone involvement and parameters of systemic bone involvement in the affected joints.Methods. Eighty consecutively evaluated premenopausal women with RA were included in the study, along with 160 healthy female control subjects who were matched to the patients by age and body mass index. Volumetric bone mineral density (vBMD), bone microarchitecture, and finite elements of biomechanical bone strength (bone stiffness and estimated failure load) at the distal radius and distal tibia were analyzed by high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with RA compared to healthy controls. In addition, in patients with RA, localized bone involvement in the metacarpophalangeal and proximal interphalangeal joints was analyzed by HR-pQCT, to identify bone erosions and osteophytes.Results. Among the 80 premenopausal women with longstanding RA, the mean AE SD age was 39.4 AE 6.7 years and mean AE SD disease duration was 9.8 AE 5.3 years. Trabecular and cortical bone parameters and bone strength at the distal radius and distal tibia were all impaired in patients with RA compared to healthy controls (each P < 0.05). In total, 75% of RA patients had evidence of bone erosions, and 41.3% of RA patients had detectable osteophytes on HR-pQCT. RA patients with bone erosions, as compared to RA patients without bone erosions, had lower cortical vBMD (at the distal radius, mean AE SD 980 AE 72 mg HA/cm 3 versus 1,021 AE 47 mg HA/cm 3 [P = 0.03]; at the distal tibia, 979 AE 47 mg HA/cm 3 versus 1,003 AE 34 mg HA/cm 3 [P = 0.04]) and higher cortical bone porosity (at the distal radius, mean AE SD 2.8 AE 2.5% versus 1.8 AE 1.6% [P = 0.04]; at the distal tibia, 3.7 AE 1.6% versus 2.7 AE 1.6% [P = 0.01]). In patients with RA, osteophyte volume at the distal radius was positively correlated with trabecular vBMD (r = 0.392, P = 0.02), trabecular number (r = 0.381, P = 0.03), and trabecular stiffness (r = 0.411, P = 0.02), and negatively correlated with trabecular separation (r = À0.364, P = 0.04), as determined by Pearson's or Spearman's correlation test.Conclusion. The findings show that premenopausal women with longstanding RA have systemic bone fragility at peripheral joint sites. Moreover, the presence of bone erosions is mainly associated with cortical bone fragility at the distal radius and tibia, and presence of osteophytes is associated with repair of trabecular bone at the distal radius.

Bony proliferations in rheumatoid arthritis, psoriatic arthritis and osteoarthritis using high‐resolution peripheral quantitative computed tomography—A systematic literature review

“…The majority of published studies reported results based on HR-pQCT of the second and third metacarpophalangeal (MCP) joints, 1,2,6,11,15,16,[18][19][20][21][22][23] but some studies additionally reported results for the fourth MCP joint, 1,3,6,15,16 and the second and third proximal interphalangeal (PIP) joints. 2,18,22 Five studies suggested that the second and third MCP joints were the most favorable sites for BPs regardless of the arthritic condition. [1][2][3]6,18 Seven studies reported results for the location of the BPs on the metacarpal head, classifying them as located in the radial, ulnar, dorsal, or palmar quadrants.…”

“…11,17 Others estimated the volume by manual and/or semi-automatic segmentation using three-dimensional dedicated computer programs, such as OsiriX and ITK-SNAP. 3,18,21 All studies reported volume estimates as mm 3 .…”

“…Six studies reported the size of BPs in patients with RA. 11,[16][17][18]23,24 Three studies measured size on a metrical scale, 11,17,18 and three studies presented the size on a semiquantitative scale. 16,23,24 One study followed the patients over a 1.5-year period and reported a significant increment in the size over time.…”

“…One study investigating patients with RA reported results regarding glucocorticoids, synthetic/conventional disease-modifying antirheumatic drugs (DMARDs), and biological DMARDs. 11,18 The study had a 1.5-year follow-up period and investigated patients treated with biological DMARDS and conventional DMARDS, observed a progression in BP size and number independent of the treatment regimen. A significant increase in BP volume was only observed in those treated with biological DMARDS and the patients switching between the two treatments.…”

Failure and multiple failure for disease modifying antirheumatic drugs in rheumatoid arthritis: Real-life evidence from a tertiary referral center in Italy

“…Longstanding disease has been associated with a worse prognosis due to chronic inflammation leading to joint and extra-articular damage in terms of bone erosions and fragility, sarcopenia and the occurence of comorbidities [22][23][24]. However, a clear definition of established RA is missing being crucial in these patients that are often at high risk to be resistant to…”