RESEARCH - Disease activity and severity in early inflammatory arthritis predict hand cortical bone loss

[Guest guest]

Rheumatology Advance Access published online on June 23, 2010

Rheumatology, doi:10.1093/rheumatology/keq181

Disease activity and severity in early inflammatory arthritis predict

hand cortical bone loss

R. Pye1, Judith E. 2, Kate A. Ward2, Diane K. Bunn3,

Deborah P. M. Symmons1 and Terence W. O’Neill1

1Arthritis Research UK Epidemiology Unit, 2Clinical Radiology, Imaging

Science and Biomedical Engineering, The University of Manchester,

Manchester and 3Faculty of Health, University of East Anglia, Norwich,

UK.

Abstract

Objectives.

To determine the influence of disease-related variables on hand

cortical bone loss in women with early inflammatory arthritis (IA),

and whether hand cortical bone mass predicts subsequent joint damage.

Method.

Adults aged 16 years with recent onset of IA were recruited to the

Norfolk Arthritis Register between 1990 and 1998, and followed

prospectively. At baseline, patients had their joints examined for

swelling and tenderness and had CRP and disease activity 28-joint

assessment score (DAS-28) measured. Radiographs of the hands were

performed in a subgroup of patients at Year 1 and at follow-up, which

were assessed using digital X-ray radiogrammetry (DXR). They were also

evaluated for the presence of erosions using Larsen’s method. Linear

mixed models were used to investigate whether disease-related factors

predicted change in DXR–areal bone mineral density (BMDa). We also

evaluated whether DXR–BMDa predicted the subsequent occurrence of

erosive disease.

Results.

Two hundred and four women, mean (S.D.) age 55.1 (14.0) years, were

included. Median follow-up between radiographs was 4 years. The mean

within-subject change in BMDa was 0.024 g/cm2 equivalent to 1% decline

per year. After adjustment for age, height and weight, compared with

those within the lower tertile for CRP, those in the upper tertile had

greater subsequent loss of bone. This was true also for DAS-28 and

Larsen score. Among those without erosions on the initial radiograph

(121), DXR–BMDa at baseline did not predict the new occurrence of

erosions.

Conclusion.

Increased disease activity and severity are associated with

accelerated bone loss. However, lower BMDa did not predict the new

occurrence of erosive disease.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/keq181v1?papetoc

Not an MD