Background Rheumatoid arthritis (RA) is associated with periarticular bone loss. In the last decade Digital X-ray Radiogrammetry (DXR) was introduced to quantify periarticular bone loss.
Objectives This Meta-analysis evaluates potential factors which influence periarticular bone loss as measured by DXR in patients with RA.
Methods A systemic literature evaluation was performed to include studies that used DXR to measure cortical periarticular bone loss at the metacarpal bones (DXR-BMD) in RA-patients. Three independent researchers assessed the quality of the studies. DXR-BMD was compared to age, gender, disease duration, C-reactive Protein (CRP), the occurrence of rheuma factor and HAQ-DI (Health Assessment Questionnaire).
Results 19 relevant studies, which fulfilled the inclusion criteria, included a quantity of 2673 RA-patients. Gender and age significantly influence DXR-BMD. A prolonged disease duration of RA was associated with a lower DXR-BMD. The Meta-analysis showed a reduced DXR-BMD (-3.3 %) in patients with elevated CRP-levels. Additionally, rheuma factor positive patients present a progressive loss of DXR-BMD.
Conclusions This Meta-analysis revealed an impact of age and gender on DXR-BMD. In this way age and gender independent parameters of bone mineral density (e. g. T-Score) should be used. Additionally, the Meta-analysis clearly verified an obvious impact of high disease activity with a pronounced inflammatory activity on periarticular mineralisation resulting in a cortical metacarpal bone loss. Consequently, DXR seems to be a diagnostic tool to evaluate bone alteration related to disease activity in RA and functions as surrogate maker for radiological progression, may be optimizing the individual therapeutic strategies.
Disclosure of Interest A. Pfeil Grant/research support from: Research Grant from Chugai Pharma Ltd, J. Böttcher: None Declared, P. Oelzner: None Declared, G. Wolf: None Declared
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