Evaluation of hand bone loss by digital X-ray radiogrammetry as a complement to clinical and radiographic assessment in early rheumatoid arthritis: results from the SWEFOT trial

Abstract

BackgroundTo investigate hand bone loss (HBL) measured by digital X-ray radiogrammetry (DXR) in patients with early rheumatoid arthritis (RA) receiving different treatment regimens, and to evaluate if DXR change rates during the first 12 months correlate with radiological damage after 24 months.MethodsFrom the total SWEFOT trial population, 159 patients had hand radiographs correctly timed and taken with same modality to be analyzed with DXR. All patients started treatment with methotrexate. After 3–4 months, patients with DAS28 > 3.2 were randomized to add sulfasalazine and hydroxychloroquine (triple therapy) or infliximab (MTX + INF). Those with DAS28 ≤3.2 were followed in regular care. Radiographic progression over 24 months was scored according to the Sharp van der Heijde score (SHS) and defined as >5 increase in T-SHS over 24 months. Hand bone mineral density (BMD) was measured by DXR at inclusion and 12 months and a change ≥2.5 mg/cm2/month was used as a cut-off for HBL.ResultsIn the MTX responders, triple therapy, and MTX + INF groups, the proportions with HBL were 4.1%, 22.2% and 16.4%, respectively (p = 0.01), and the mean (SD) radiological progression in these groups was 3.91 (6.72), 7.40 (14.63) and 2.72 (4.55) respectively (p = 0.06). Patients with HBL had significantly greater risk for radiographic progression, compared with patients without HBL (odds ratio 3.09, 95% CI =1.20–7.79, p = 0.02).ConclusionsNon-responders to MTX had a significantly greater risk of HBL than MTX-responders, despite the add-on therapies. Patients with HBL during the 12 months had greater risk of radiographic progression after 24 months. Evaluation of HBL may help to identify patients who are at risk of radiographic progression.

Association of Low Bone Mineral Density with Anti-Citrullinated Protein Antibody Positivity and Disease Activity in Established Rheumatoid Arthritis: Findings from a US Observational Cohort

“…A comparison of DXR and dual-energy X-ray absorptiometry (DXA) revealed that DXR appears to be more sensitive than DXA in detecting early bone loss in patients with RA [ 9 ]. Several studies have demonstrated a treatment effect of conventional and biologic disease-modifying antirheumatic drugs (bDMARDs) on BMD loss using DXR [ 4 , 12 – 17 ]; however, data are limited on identifying factors that are associated with BMD loss. Given the correlation of DXR–BMD with increased fracture risk and mortality [ 7 , 8 ], it would be beneficial to identify a reliable prognostic factor that is associated with hand BMD loss and treatment outcomes in patients with RA.…”

Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

“…[16][17][18][19] Compared with CR, which reportedly only detects damage if the reduction in bone density is more than 35%, 16 17 31 digital BMD measuring has a higher sensitivity. This may be important in the clinic when DMARDs may halt or slow down progression to a point where the CR method is not sensitive enough to measure a difference.…”

“…The interclass correlation coefficient was 0.94 and the smallest detectable difference (SDD) in SHS was 5.8 units. 16 …”

Diagnostic and prognostic potential of joint imaging in patients with anti-citrullinated protein antibodies

“…Bone loss detected by this method has repeatedly been shown to predict radiographic joint progression in early RA. [85][86][87][88]. However, the majority of previous studies investigated 12-months changes in DXR-BMD, and after this time, DXR-evaluation of joint damage was not superior to conventional radiography for prediction of further radiologic progression Except QCT, which measures bone mineral mass per volume, the other methods measure per projected area.…”