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Extended report
Differences in bone structure between rheumatoid arthritis and psoriatic arthritis patients relative to autoantibody positivity
  1. Roland Kocijan1,2,
  2. Stephanie Finzel1,
  3. Matthias Englbrecht1,
  4. Klaus Engelke3,
  5. Juergen Rech1,
  6. Georg Schett1
  1. 1Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
  2. 2St. Vincent Hospital – Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Austria
  3. 3Institute of Medical Physics, University of Erlangen-Nuremberg, Erlangen, Germany
  1. Correspondence to Professor Georg Schett, Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, Erlangen D-91054, Germany; georg.schett{at}


Objective To investigate whether trabecular and cortical bone structure differ between patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). So far, no study has performed a detailed comparative analysis of bone structure in patients with RA and PsA.

Methods 110 patients (60 RA, 50 PsA) received high-resolution peripheral quantitative CT of the distal radius. Demographic and disease-specific parameters including anti-rheumatic treatment, bone erosion status and previous fractures were recorded.

Results RA and PsA patients were comparable in age, gender, body mass index, disease duration, disease activity, functional status, antirheumatic treatment and bone erosion status. No significant differences were found for volumetric bone mineral density (BMD), including total BMD (300±77 vs 316±62 mgHA/cm3), trabecular BMD (152±46 vs 165±40 mgHA/cm3) and cortical BMD (787±113 vs 818±76 mgHA/cm3) when comparing RA patients to PsA patients, respectively. However, in contrast to seronegative RA, seropositive RA showed significantly reduced trabecular BMD (p=0.007), bone volume per tissue volume (p=0.007) and trabecular number (p=0.044), as well as a strong trend towards higher trabecular inhomogeneity compared to PsA patients. In the regression analysis, higher age, female gender and presence of autoantibodies were independently associated with trabecular bone loss.

Conclusions Seropositive RA exhibits more profound changes in trabecular bone architecture than seronegative RA or PsA. The data support the concept that seropositive RA is a disease entity that is distinct from seronegative RA and PsA.

  • Psoriatic Arthritis
  • Rheumatoid Arthritis
  • Bone Mineral Density
  • Osteoporosis

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