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Hand bone densitometry: a more sensitive standard for the assessment of early bone damage in rheumatoid arthritis
  1. Glenn Haugeberg (glenn.haugeberg{at}sshf.no)
  1. Sørlandet Hospital, Norway
    1. Michael J Green (drmjgreen{at}hotmail.com)
    1. University of Leeds, United Kingdom
      1. Philip G Conaghan (p.conaghan{at}leeds.ac.uk)
      1. University of Leeds, United Kingdom
        1. Mark Quinn (mark.quinn{at}york.nhs.uk)
        1. University of Leeds, United Kingdom
          1. Richard Wakefield (medrjw{at}leeds.ac.uk)
          1. University of Leeds, United Kingdom
            1. Susanna M Proudman
            1. Royal Adelaide Hospital, Australia
              1. Sheena Stewart
              1. University of Leeds, United Kingdom
                1. Elizabeth Hensor
                1. University of Leeds, United Kingdom
                  1. Paul Emery (p.emery{at}leeds.ac.uk)
                  1. University of Leeds, United Kingdom

                    Abstract

                    Objective: To examine the role of hand dual energy x-ray absorptiometry (DEXA) compared to radiography in the assessment of bone involvement in early Rheumatoid arthritis (RA) patients with active disease.

                    Methods: The study population (n=79) had RA of less than 12 months duration and were selected for poor prognostic features. Clinical and bone mineral density (BMD) data were collected at baseline, 24 and 48 weeks. Hand radiographs were performed at baseline and 48 weeks. Bone damage analyses were performed at the group level and at the individual level by applying the method of smallest detectable change (SDC).

                    Results: At baseline mean disease duration was 8.5 months, ESR 34.3 mm/hour, CRP 40.2 mg/liter, HAQ 1.35 and 81% were rheumatoid factor positive. Mean (95% CI) hand BMD loss was 2.5% (-3.5, -1.5) at 24 weeks and 2.6% (-3.8, -1.5) at 48 weeks. Individual hand bone loss exceeding SDC was seen in 46.8% at 24 weeks and in 58.2% at 48 weeks. In the subgroup of 58 patients with radiographs performed, radiographic joint damage score evaluated by Sharp-van der Heidje method increased from 4.8 to 10.6 (p=0.001). Individual hand bone loss in this subgroup exceeding SDC was seen in 50.0% at 24 weeks and in 56.9% at 48 weeks, whereas at 48 weeks only 22.4% had detoriated in modified Sharp score.

                    Conclusion: Our study support that hand DEXA, compared with radiographic joint damage scores is a more sensitive tool than radiology for measuring disease related bone damage in early RA.

                    • bone densitometry
                    • early rheumatoid arthritis
                    • smallest detectable change

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