Decrease in bone mineral density during three months after diagnosis of early rheumatoid arthritis measured by digital X-ray radiogrammetry predicts radiographic joint damage after one year

摘要

Background Periarticular osteopenia is an early sign of incipient joint injury in rheumatoid arthritis (RA), but cannot be accurately quantified using conventional radiography. Digital X-ray radiogrammetry (DXR) is a computerized technique to estimate bone mineral density (BMD) from hand radiographs. The aim of this study was to evaluate whether decrease in BMD of the hands (BMD loss), as determined by DXR 3?months after diagnosis, predicts radiographic joint damage after 1 and 2?years in patients with early RA. Methods Patients (n?=?176) with early RA ( 2/month and as severe when the decrease was greater than 2.5?mg/cm2/month. Multivariate regression was applied to test the association between DXR-BMD loss and radiographic damage, including adjustments for possible confounders. Results DXR-BMD loss during the initial 3?months occurred in 59% of the patients (44% moderate, 15% severe): 32 patients (19%) had radiographic progression at 1?year and 45 (35%) at 2?years. In multiple regression analyses, the magnitude of DXR-BMD loss was significantly associated with increase in Larsen score between baseline and 1?year ( p =?0.033, adjusted R -squared?=?0.069). Conclusion DXR-BMD loss during the initial 3?months independently predicted radiographic joint damage at 1?year in patients with early RA. Thus, DXR-BMD may be a useful tool to detect ongoing joint damage and thereby to improve individualization of therapy in early RA.