RESEARCH - Cortical hand bone loss after one year in early RA predicts radiographic hand joint damage at 5 and 10 year follow-up

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Ann Rheum Dis. Published Online First: 13 March 2008.

doi:10.1136/ard.2007.085985

Copyright © 2008 BMJ Publishing Group Ltd & European League Against

Rheumatism

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Extended Report

Cortical hand bone loss after one year in early rheumatoid arthritis

predicts radiographic hand joint damage at 5 and 10 year follow-up

Mari Hoff 1*, Glenn Haugeberg 2, Sigrid degård 3, Silje W Syversen 3,

Landewé 4, Désirée van der Heijde 5 and Tore K Kvien 3

1 St. Olavs Hospital, Norwegian University of Science and Technology,

Trondheim, Norway

2 Sørlandet Hospital, Norwegian University of Science and Technology,

Trondheim, Norway

3 Diakonhjemmet Hospital, Norway

4 University of Maastricht, Netherlands

5 Leiden University Medical Center, Netherlands

Abstract

Objective: To examine one year hand bone loss in early Rheumatoid

Arthritis (RA) as a predictor of radiographic damage at 5 and 10 years

follow-up.

Methods: 136 RA patients (disease duration 0-4 years) were followed

for 10 years with clinical data and hand radiographs. Joint damage was

scored according to the van der Heijde modification of the Sharp

method (vdH Sharp score) and hand bone mineral density (BMD) was

measured by digital x-ray radiogrammetry (DXR). Group comparisons,

correlation analyses and multivariate analyses were performed to

evaluate the relationship between hand bone loss and radiographic

joint damage.

Results: Patients with hand BMD loss at 1 year had a higher median

increase in vdH Sharp score compared to patients without loss at both

5 (12 vs. 2, p=0.001) and 10 years (22 vs. 4, p=0.002). In a linear

regression model adjusting for age, gender, baseline CRP, anti-CCP,

IgM RF and radiographic damage, absolute hand DXR-BMD loss at one year

was an independent predictor of radiographic outcome at both 5

(p<0.01) and 10 year (p=0.02). In a logistic regression model the odds

ratio (95% CI) for radiographic progression among patients with hand

BMD loss was 3.5 (1.4-8.8) and 3.5 (1.4-8.4) at 5 and 10 years,

respectively.

Conclusion: Early hand bone loss measured by DXR-BMD was an

independent predictor of subsequent radiographic damage. Our findings

support that quantitative hand bone loss in RA precedes radiographic

joint damage and may be used as a tool for assessment of bone

involvement in RA.

http://ard.bmj.com/cgi/content/abstract/ard.2007.085985v1?papetoc

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