Background The issues of early visualizing of the changes in the joints and bone which can be used as predictors of future joints structural damage are being discussed.
Objectives To assess changes in the BMD in patients with ERA and how the BMD is related to the erosive changes of the wrist on MRI.
Methods The study involved 56 patients with early rheumatoid arthritis (ERA) who had suffered of articular syndrome for 1 year (average 9.3±2.4 months). The diagnosis was established against the RA classification criteria EULAR/ARC '2010. Clinical and laboratory studies included: DAS28, ESR, RF, anti-CCP, anti-CMV tests. Hands were radiographed at baseline. BMD of the distal radius and lumbar spine were assessed by DEXA “Challenger” (DMS, France). MRIs of the patient's dominant wrist and 2nd–5th metacarpophalangeal (MCP) joints were obtained using 1.5 T MRI “MAGNETOM Espree” (Siemens) with contrast enhancement.
Results The DEXA showed bone loss in patients with ERA. When analyzing the lumbar spine osteoporosis was found in 3 patients (5,4%) and osteopenic syndrome was identified in 21 patients (37,5%). In the study of the distal radius the more substantial bone loss was established. Thus, osteoporosis was diagnosed in 12 patients (21,4%), osteopenic syndrome in 32 patients (57,1%). The BMD decrease at the distal radius correlated with DAS28 (r=-0,57; P<0,001), ESR (r=-0,41; P<0,05). As for BMD of the lumbar spine, only the correlation with DAS28 was found. All patients with seropositive rheumatoid arthritis showed a significant decrease in bone mineral density at both the lumbar spine and distal radius. Bone erosions were identified with standard radiography in 12 patients. Most of the erosions were located in the bones of the wrist and in 2 patients they were located in the head section of metacarpal bones. vdHS system demonstrated the score of 12±34.7 points of average erosions. Detection of erosions on radiographs correlated with the presence of synovitis hand joints, clinically established (r=0,40; P<0,05), DAS28 (r=0,48; P<0,01), seropositivity for the three antibodies (r=0,52; P<0,01). At the same time all patients with radiographic erosions suffered of the decrease in BMD of the distal radius (r=-0,67; P<0,01). However, assessment of the changes in mineral density of the lumbar spine did not demonstrate such correlation. MRI of the dominant wrist revealed the next MR symptoms: swelling of the bone marrow in 54 patients (96,4%), synovitis in 40 patients (71,4%), erosions in 34 patients (60,7%). MRI detected the erosions 2.78 times more cases than the conventional radiography. Erosion was confirmed, especially in patients with a high rate of DAS28, in seropositive patients, and those with the synovitis. Strong correlation between BMD of the distal radius and the presence of erosions detected by MRI (r=-0,72; P<0,001), and lumbar spine BMD and erosions (r =-0,48; P<0,01) was established.
Conclusions The results of this study prove that the decrease in BMD correlates with the erosions of the dominant wrist and 2nd–5th MCP joints detected by standard radiographs and MRI. Thus, the BMD changes can be predicted early by the development of erosive process in patients with ERA. The early loss of a wrist bone tissues, measured in the first year of the disease using the DRA is an independent predictor of erosive progression.
Disclosure of Interest None declared
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