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

BACKGROUND: To 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. METHODS: From 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/cm(2)/month was used as a cut-off for HBL. RESULTS: In 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). CONCLUSIONS: Non-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

Long-term in-vitro precision of direct digital X-ray radiogrammetry

Digital X-ray radiogrammetry (DXR) calculates peripheral bone mineral density (BMD) from hand radiographs. The short-term precision for direct DXR has been reported to be highly satisfactory. However, long-term precision for this method has not been examined. Thus, the aim of this study was to examine the long-term in-vitro precision for the new direct digital version of DXR. The in-vitro precision for direct DXR was tested with cadaver phantoms on four different X-ray systems at baseline, 3 months, 6 months, and in one machine also at 12 months. At each time point, 31 measurements were performed. The in-vitro longitudinal precision for the four radiographic systems ranged from 0.22 to 0.43% expressed as coefficient of variation (CV%). The smallest detectable difference (SDD) ranged from 0.0034 to 0.0054 g/cm(2). The in vitro long-term precision for direct DXR was comparable to the previous reported short-term in-vitro precision for all tested X-ray systems. These data show that DXR is a stable method for detecting small changes in bone density during 6-12 months of follow-up

Prediction of disease progression in early rheumatoid arthritis. A study of some imaging and laboratory variables.

Objective: To investigate the role of magnetic resonance imaging (MRI), assessment of bone mineral density (BMD) and antibodies to citrullinated proteins (anti-CCP) in predicting radiologic outcome in patients with early rheumatoid arthritis (RA). Patients: All patients were included in the BARFOT programme (baseline). The patients had rheumatoid arthritis of recent onset with mean disease duration of about six months. The mean age at inclusion was 55 years and two thirds were women. Methods: MRI and conventional radiography (CR) of the knee joint and forefoot were performed in 30 patients at baseline, and after 1 and 3 years. The MRI examination included evaluation of inflammation using a synovitis score and of destruction with an erosion score. BMD was measured by DEXA in 204 patients at baseline, in lumbar spine and the hip. At the same time and after 2 years radiographs of the hands and forefoot were obtained and evaluated according to the Larsen method. Anti- CCP was assessed at baseline in 379 patients. Radiographs of hands and feet were obtained at baseline and after 2 years and evaluation according to the Larsen method with respect to joint damage and progression was performed. Major findings: Baseline MRI- synovitis of the knee and of the 5th MTP joint tended to persist over time even when clinical synovitis had disappeared. MRI of the knee but not of the forefoot was superior to CR as regards the ability to detect erosions. Baseline MRI- synovitis of the knee correlated significantly with the number of MRI- erosions after one and three years and proved to be a predictor of erosivness. Also baseline MRI-synovitis of the 5th MTP joint tended to be associated with future development of erosions. DEXA measurements showed that reduced bone mass (RBM) was frequent already within one year of first symptom or sign of RA. T- and Z-scores correlated with Larsen scores at baseline and after 2 years in the total patient cohort but when calculated separately, significant correlations were found only in women. Furthermore, women but not men with RBM and osteoporosis had higher Larsen scores at baseline and after 2 years than those without. In a stepwise multiple regression analysis of women, Z-score trochanter and baseline CRP were selected as independent predictors of joint damage. Presence of anti-CCP was associated with higher Larsen score both at baseline and after 2 years. Univariate predictor analysis revealed that, after Larsen score, anti-CCP had the highest significant odds ratio for radiologic damage and progression. In stepwise multiple regression analyses, baseline Larsen score, anti-CCP and ESR were selected as independent predictors for radiological outcome. Conclusion: The results presented in the present thesis suggest that, even if prediction of disease outcome in early RA is still at a distance from perfection, the use of MRI, measurement of BMD and assessment of anti-CCP in clinical practice may contribute to improve the ability of the treating rheumatologist to make the best possible treatment decisions

MRI evidence of persistent joint inflammation and progressive joint damage despite clinical remission during treatment of early rheumatoid arthritis.

To determine the value of magnetic resonance imaging (MRI) of bones and joints in patients with recent-onset rheumatoid arthritis (RA) treated for 2 years from diagnosis with disease-modifying anti-rheumatic drugs (DMARDs) and glucocorticoids

Arthritis Research &amp

Abstract Introduction: The aim of this study was to investigate the role of hand bone mineral density (BMD) loss analyzed with digital X-ray radiogrammetry (DXR) in early rheumatoid arthritis (RA) as a predictor for progression of joint damage

Comparing Five Year Out-Come in Two Cohorts of Patients with Early Rheumatoid Arthritis - A BARFOT Study.

The objective of the study was to compare disease characteristics over the first 5 years of disease in patients with RA, with disease onset in 1990s and 2000s, respectively