RESEARCH - Hand bone loss in early undifferentiated arthritis: evaluating BMD loss before the development of RA

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ls of the Rheumatic Diseases 2006;65:736-740;

doi:10.1136/ard.2005.043869

© 2006 by BMJ Publishing Group Ltd & European League Against Rheumatism

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EXTENDED REPORT

Hand bone loss in early undifferentiated arthritis: evaluating bone mineral

density loss before the development of rheumatoid arthritis

G Haugeberg, M J Green, M A Quinn, H Marzo-Ortega, S Proudman, Z Karim, R J

Wakefield, P G Conaghan, S and P Emery

Academic Section of Musculoskeletal Disease, Leeds Institute of Molecular

Medicine, University of Leeds, Leeds, UK

Objectives: (1) To examine the change in regional bone mineral density

(BMD), including the hands, and assess its role as a predictor of outcome in

patients presenting with an early undifferentiated inflammatory arthritis;

(2) to examine for associations with the changes in hand BMD.

Methods: 74 patients with undifferentiated hand arthritis of less than 12

months' duration were examined at baseline and then at three, six, and 12

months follow up, including BMD measurement of the femoral neck, spine

(L2-4), and the whole hands using dual energy absorptiometry (DXA).

Results: During the study, 13 patients were diagnosed as having rheumatoid

arthritis, 19 as having inflammatory non-rheumatoid joint disorders, and 42

as having non-inflammatory joint disorders. At the femoral neck and lumbar

spine no significant bone loss was seen in any of the three subgroups. At

the 12 months follow up the mean (95% confidence interval) hand BMD loss in

the patients with rheumatoid arthritis was -4.27% (-1.41 to -7.13); in the

inflammatory non-rheumatoid group, -0.49% (-1.33 to +0.35); and in the

non-inflammatory joint disorder group, -0.87% (-1.51 to -0.23). In a

multivariate linear regression model (including age, rheumatoid factor, mean

C reactive protein, mean HAQ score, and cumulative glucocorticoid dose),

only mean C reactive protein (p<0.001) and rheumatoid factor (p = 0.04) were

independently associated with change in hand BMD during follow up.

Conclusions: Hand DXA provides a very sensitive tool for measuring bone loss

in early rheumatoid arthritis and may be useful in identifying patients at

high risk of developing progressive disease. Further studies are needed to

evaluate the role of hand bone loss as a prognostic factor and outcome

measure in rheumatoid arthritis.

http://ard.bmjjournals.com/cgi/content/abstract/65/6/736

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