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Extended report
Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study
  1. K V C Wevers-de Boer1,
  2. L Heimans1,
  3. K Visser1,
  4. J Kälvesten2,3,
  5. R J Goekoop4,
  6. M van Oosterhout5,
  7. J B Harbers6,
  8. C Bijkerk7,
  9. M Steup-Beekman8,
  10. M P D M de Buck9,
  11. P B J de Sonnaville10,
  12. T W J Huizinga1,
  13. C F Allaart1
  1. 1Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands
  2. 2Sectra, Linköping, Sweden
  3. 3CMIV Linköping University, Linköping, Sweden
  4. 4Department of Rheumatology, Haga Hospital, The Hague, Zuid-holland, The Netherlands
  5. 5Department of Rheumatology, Groene Hart Hospital, Gouda, Zuid-holland, The Netherlands
  6. 6Department of Rheumatology, Franciscus Hospital, Roosendaal, The Netherlands
  7. 7Department of Rheumatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
  8. 8Bronovo Hospital, The Hague, Zuid-holland, The Netherlands
  9. 9Department of Rheumatology, MCH, The Hague, Zuid-holland, The Netherlands
  10. 10Oosterschelde Hospital, Goes, The Netherlands
  1. Correspondence to K V C Wevers-de Boer, Department of Rheumatology, Leiden University Medical Center, PO BOX 9600, Leiden 2300 RC, The Netherlands; k.v.c.de_boer{at}


Aim To assess whether in early (rheumatoid) arthritis (RA) patients, metacarpal bone mineral density (BMD) loss after 4 months predicts radiological progression after 1 year of antirheumatic treatment.

Methods Metacarpal BMD was measured 4 monthly during the first year by digital X-ray radiogrammetry (DXR-BMD) in patients participating in the IMPROVED study, a clinical trial in 610 patients with recent onset RA (2010 criteria) or undifferentiated arthritis, treated according to a remission (disease activity score<1.6) steered strategy. With Sharp/van der Heijde progression ≥0.5 points after 1 year (yes/no) as dependent variable, univariate and multivariate logistic regression analyses were performed.

Results Of 428 patients with DXR-BMD results and progression scores available, 28 (7%) had radiological progression after 1 year. Independent predictors for radiological progression were presence of baseline erosions (OR (95% CI) 6.5 (1.7 to 25)) and early DXR-BMD loss (OR (95% CI) 1.5 (1.1 to 2.0)). In 366 (86%) patients without baseline erosions, early DXR-BMD loss was the only independent predictor of progression (OR (95% CI) 2.0 (1.4 to 2.9)).

Conclusions In early RA patients, metacarpal BMD loss after 4 months of treatment is an independent predictor of radiological progression after 1 year. In patients without baseline erosions, early metacarpal BMD loss is the main predictor of radiological progression.

  • Early Rheumatoid Arthritis
  • Bone Mineral Density
  • Outcomes research

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