Relationship between early bone mineral density changes and long‐term function and radiographic progression in rheumatoid arthritis

Abstract

Objective. To ascertain whether bone mineral density loss during the first year of treatment for early rheumatoid arthritis (RA) as assessed by dual x-ray absorptiometry (DXA) is associated with long-term function, quality of life, and radiographic progression. Methods. Early RA patients, prior to commencing disease-modifying antirheumatic drug therapy, underwent evaluation with DXA scans of both hands, femoral neck, and lumbar spine at the time of diagnosis, then at 1 year and final followup at >6 years. Clinical and laboratory data and hands and feet radiographs were obtained at baseline and final followup. Results. Sixty-four patients were assessed. At baseline, median disease duration was 6 months, mean 28-joint Disease Activity Score was 5.85, and median Health Assessment Questionnaire score was 1.38. Median followup was 6.4 years (range 5.1-7.2 years). For erosion scores, 86% of patients with hand bone density loss above the smallest detectable change after 1 year progressed versus 55% of those with no hand bone density loss (P ‫؍‬ 0.006). However, baseline radiographs showed a similar strength of association. Eighty-four percent of patients with erosions at baseline had erosion progression versus 57% of those with no baseline erosions (P ‫؍‬ 0.021). Additionally, first-year bone density loss was not associated with function and quality of life status at followup. Conclusion. Hand bone loss during the first year of treatment in early RA, as assessed with DXA, was associated with a high likelihood of radiographic progression; however, in the current study this was not superior to baseline radiographs. Furthermore, it was not associated with patient-reported outcomes.

Decline in Hand Bone Mineral Density Indicates Increased Risk of Erosive Change in Early Rheumatoid Arthritis

“…Several previous studies have identified BMD loss as a predictor of long‐term joint damage over periods of up to 20 years (). More recently, Bejarano and coworkers () also demonstrated an association between DXA‐measured hand BMD loss in the first year and long‐term radiographic progression (6.4‐year followup) in a smaller (n = 64) early RA cohort. However, they concluded that hand BMD loss did not provide any additional information over and above the presence of erosions on baseline radiographs of the hands and feet.…”

Hand bone mass in rheumatoid arthritis: A review of the literature

“…A longitudinal study of 50 patients with early RA (whose hand BMD was measured at baseline, 6 and 12 mo) indicated that the baseline value of hand BMD was associated with radiographic scores at 12 mo [27] . Another longitudinal study consisting of 64 patients with RA confirmed the predictive value of hand BMD loss in the first year for the subsequent radiographic progression (6.4 year follow up) [35] . A longitudinal study by Black et al [37] showed hand BMD loss in the first 6 mo might be a predictor for erosions at 12 mo.…”

“…Several longitudinal studies suggested that early hand bone loss may have predictive value to determine which patients with early RA will develop further radiographic progression or have poor functional status [26,27,31,35,37] . However, there are contrasting results.…”

“…However, 2 longitudinal studies failed to show a significant association between hand bone loss and functional status [4,35] .…”

Romatizmal Hastalıklarda Osteoporozun Etiyopatogenezi

“…Erken dönem RA'da görülen sinovit ve periartiküler kemik kaybı kemik hasarının oluşumu ve progresyonu için belirleyicidir (8). Yapılan çalışmalarda, erken dönem RA'da, elde görülen kemik kaybı ile radyolojik ilerleme ilişkili bulunmuştur (11,12). Erken dönem RA'lı hastalarda saptanan el KMY kaybı, bir yıldan daha fazla zamandır remisyonda olan hastalarda %0,03 iken, düşük hastalık aktivitesi olanlarda %2,03, yüksek hastalık aktivitesi olanlarda ise %3,13 olarak saptanmıştır (13).…”