Value of digital X‐ray radiogrammetry in the assessment of inflammatory bone loss in rheumatoid arthritis

Pfeil, Alexander; Haugeberg, Glenn; Hansch, Andreas; Renz, Diane M.; Lehmann, G.; Malich, Ansgar; Wolf, Günter; Böttcher, Joachim

doi:10.1002/acr.20423

Cited by 36 publications

(21 citation statements)

References 83 publications

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“…Recent advances in computer-aided diagnosis now offer the opportunity for a standardized measurement of radiographically visible alterations focusing on the small joints of the hand [3], with a focus on the assessment of joint space widths [4]. Computer-based methods for the measurement of joint space width could provide substantial advantages in comparison with the assessment of joint space narrowing by manual scoring methods, because of improved standardization, sensitivity, and reproducibility [5,6].…”

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confidence: 99%

Joint damage in rheumatoid arthritis: assessment of a new scoring method

et al. 2013

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IntroductionThe aim of this study was to assess a novel approach for the quantification of finger joint space narrowing and joint destruction in patients with rheumatoid arthritis (RA) focusing on the peripheral hand articulations.MethodsA total of 280 patients with verified RA underwent computerized semi-automated measurements of joint space distance at the finger articulations based on radiographs. The Z-Score, which can differentiate between joint space alterations caused by RA versus age/gender-related changes, was calculated as a comparative parameter. The severity of joint space narrowing was also quantified by the Sharp Score. Sensitivity and specificity of the Z-Score (based on joint space widths differentiated for each peripheral finger joint) were evaluated to reveal the potential for the occurrence of erosions. Additionally, the potential of the Z-Score regarding the differentiation of therapeutic effects on joint space widths in patients under a therapy of methotrexate versus leflunomide was performed.ResultsThe Z-Scores of finger articulations in patients with RA were generally decreased. Metacarpal-phalangeal (MCP) joint articulations showed a continuous significant decline of -1.65 ± 0.30 standard deviations dependent on the Sharp Score. The proximal-interphalangeal joints also revealed a significant reduction of the Z-Score (-0.96 ± 0.31 standard deviations). The sensitivity and specificity of MCP joint space distance for the detection of erosions were 85.4% versus 55.2%. The Sharp Score for joint space narrowing was not able to detect different treatments, whereas an accentuated stabilization of joint space narrowing could be identified for the Z-Score of the MCP joints in patients treated with leflunomide and methotrexate.ConclusionThe Z-Scoring method based on computer-aided analysis of joint space widths was able to reliably quantify severity-dependent joint space narrowing in RA patients. In the future, calculation of a Z-Score based on gender-specific and age-specific reference data shows the potential for a surrogate marker of RA progression that comprehends the early identification of patients with RA, and in particular those with erosive course of the disease, enabling a timely therapeutic strategy for cartilage protection.

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confidence: 99%

Joint damage in rheumatoid arthritis: assessment of a new scoring method

et al. 2013

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“…The DXR method measures MCI at the metacarpal bones II to IV with a high precision and in a highly reproducible way [8, 9]. The main field of application of the DXR is the quantification of periarticular metacarpal bone loss in patients with RA [10]. The periarticular bone loss as detected by the MCI is strongly associated with the disease activity in RA [11].…”

Section: Introductionmentioning

confidence: 99%

“…The periarticular bone loss as detected by the MCI is strongly associated with the disease activity in RA [11]. Cross-sectional studies have shown a strong association between reduced metacarpal index as measured by DXR and radiographically visible joint destruction [12–15], indicating that DXR-estimates function as surrogate marker of radiographic progression [10]. Longitudinal studies have also confirmed that early periarticular bone loss may be a predictor of subsequent radiographic joint damage [16–19].…”

Section: Introductionmentioning

confidence: 99%

Metacarpal bone loss in patients with rheumatoid arthritis estimated by a new Digital X-ray Radiogrammetry method – initial results

Pfeil

Thodberg²,

Renz

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe Digital X-ray Radiogrammetry (DXR) method measures the cortical bone thickness in the shafts of the metacarpals and has demonstrated its relevance in the assessment of hand bone loss caused by rheumatoid arthritis (RA). The aim of this study was to validate a novel approach of the DXR method in comparison with the original version considering patients with RA.MethodThe study includes 49 patients with verified RA. The new version is an extension of the BoneXpert method commonly used in pediatrics which has these characteristics: (1) It introduces a new technique to analyze the images which automatically validates the results for most images, and (2) it defines the measurement region relative to the ends of the metacarpals. The BoneXpert method measures the Metacarpal Index (MCI) at the metacarpal bone (II to IV). Additionally, the MCI is quantified by the DXR X-posure System.ResultsThe new version correctly analyzed all 49 images, and 45 were automatically validated. The standard deviation between the MCI results of the two versions was 2.9% of the mean MCI. The average Larsen score was 2.6 with a standard deviation of 1.3. The correlation of MCI to Larsen score was −0.81 in both versions, and there was no significant difference in their ability to detect erosions.ConclusionThe new DXR version (BoneXpert) validated 92% of the cases automatically, while the same good correlation to RA severity could be presented compared to the old version.

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“…A common application of DXR is the quantification of inflammatory-associated periarticular metacarpal bone loss in patients with RA [6]. Periarticular bone loss detected by DXR is strongly associated with disease activity in RA [7] and radiographic progression [8].…”

Section: Introductionmentioning

confidence: 99%

Psoriatic arthritis is associated with bone loss of the metacarpals

et al. 2016

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BackgroundBoneXpert (BX) is a newly developed medical device based on digital X-ray radiogrammetry to measure human cortical bone thickness. The aim of this study was to quantify cortical bone loss of the metacarpals in patients with psoriatic arthritis (PsA) and compare these findings with other radiological scoring methods.MethodsThe study includes 104 patients with verified PsA. The BX method was used to measure the Metacarpal Index (MCI) at the metacarpal bones (II–IV). Additionally, the T-score of the MCI (T-scoreMCI) was calculated. Radiographic severity was determined by the Psoriatic Arthritis Ratingen Score (Proliferation Score and Destruction Score) as published by Wassenberg et al. and the Psoriatic Arthritis modified van der Heijde Sharp Score (Joint Space Narrowing Score and Erosion Score).ResultsFor the total PsA study cohort, the T-scoreMCI was significantly reduced by −1.289 ± 1.313 SD. The MCI negatively correlated with the Proliferation Score (r = −0.732; p < 0.001) and the Destruction Score (r = −0.771; p < 0.001) of the Psoriatic Arthritis Ratingen Score. Lower coefficients of correlations were observed for the Psoriatic Arthritis modified van der Heijde Sharp Score. In this context, a severity-dependent and PsA-related periarticular demineralisation as measured by the MCI was quantified. The strongest reduction of −30.8 % (p < 0.01) was observed for the MCI in the Destruction Score.ConclusionsThe BX MCI score showed periarticular demineralisation and severity-dependent bone loss in patients with PsA. The measurements of the BX technique were able to sensitively differentiate between the different stages of disease manifestation affecting bone integrity and thereby seem to achieve the potential to be a surrogate marker of radiographic progression in PsA.

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Value of digital X‐ray radiogrammetry in the assessment of inflammatory bone loss in rheumatoid arthritis

Cited by 36 publications

References 83 publications

Joint damage in rheumatoid arthritis: assessment of a new scoring method

Joint damage in rheumatoid arthritis: assessment of a new scoring method

Metacarpal bone loss in patients with rheumatoid arthritis estimated by a new Digital X-ray Radiogrammetry method – initial results

Psoriatic arthritis is associated with bone loss of the metacarpals

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