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Brance ML, Razzini A, Pons-Estel BA, Quagliato NJ, Jorfen M, Berbotto G, Brun LR. Whole-hand and regional bone mineral density involvement in rheumatoid arthritis. REUMATOLOGIA CLINICA 2023; 19:555-559. [PMID: 38056980 DOI: 10.1016/j.reumae.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/22/2023] [Indexed: 12/08/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by symmetric polyarthritis that can lead to joint deformity, disability, and osteoporosis. We aimed to evaluate whole hand and regional BMD in RA patients compared to controls. In addition, we evaluated the BMD of dominant versus non-dominant hands in healthy subjects. We included adult female and male RA patients and control subjects matched by age, sex, and BMI. BMD (g/cm2) was measured by DXA in lumbar spine (LS), whole hand, and three regions of interest: carpus, metacarpal bones, and phalanges. Results: 44 control subjects (49.5±11.8 y) and 60 with RA (52.7±12.7 y) were included. Significant lower BMD in RA patients was found in LS (-8.7%), dominant whole hand (-9.5%), carpus, metacarpal bones, and phalanges, and non-dominant whole hand (-8.7%), metacarpal bones, and phalanges compared to controls. A significant positive correlation was found between LS and whole-hand BMD (dominant r=.63, non-dominant r=.67). Finally, the whole hand, metacarpal bones, and carpus BMD measurements were significantly higher in the dominant hand compared to the non-dominant hand without differences in the phalangeal ROI. In conclusion, hand BMD was significantly lower in RA patients compared to control subjects and there was a significant correlation with LS BMD. We demonstrated that BMD measurements of the whole-hand, and different ROI (carpus, metacarpal bones, and phalanges) by DXA would be an easily reproducible technique to evaluate bone loss. In addition, the whole hand, metacarpal bones and carpus BMD measurements were significantly higher in the dominant hand compared to the non-dominant hand without differences in the phalanges.
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Affiliation(s)
- María Lorena Brance
- Reumatología y Enfermedades Óseas, Rosario, Argentina; Laboratorio de Biología Ósea, Universidad Nacional de Rosario, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
| | - Agustín Razzini
- Reumatología y Enfermedades Óseas, Rosario, Argentina; Laboratorio de Biología Ósea, Universidad Nacional de Rosario, Argentina
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | | | | | | | - Lucas R Brun
- Laboratorio de Biología Ósea, Universidad Nacional de Rosario, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
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Liu YQ, Liu Y, Chen ZY, Li H, Xiao T. Rheumatoid arthritis and osteoporosis: a bi-directional Mendelian randomization study. Aging (Albany NY) 2021; 13:14109-14130. [PMID: 34015765 PMCID: PMC8202858 DOI: 10.18632/aging.203029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
Many observation studies have demonstrated a close relationship between rheumatoid arthritis (RA) and osteoporosis (OP). However, the causal genetic correlation between RA and OP remains unclear. In this study, we performed bi-directional Mendelian randomization (MR) analyses to explore causal inference between these two traits. The instrumental variables for RA were selected from a large-scale genome-wide association study (GWAS) (1,523 cases and 461,487 controls). Bone mineral density (BMD) at five different sites (heel (n=265,627), forearm (FA) (n=8,143), femoral neck (FN) (n=32,735), lumbar spine (LS) (n=28,498), and total body (n=28,498)) were used as phenotypes for OP. The inverse variance weighted (IVW) method did not detect any causal effect of BMDs on RA except heel BMD (beta = -7.57 × 10-4, p = 0.02). However, other methods (MR-Egger, weighted median, weighted mode, MR-PRESSO, and MR-RAPS) showed no causal association between heel BMD and RA. Likewise, we did not find a causal effect of RA on BMD at any sites. In conclusion, we found no evidence that RA is causally associated with OP/BMD, or vice versa. We suggested that the associations found in previous observational studies between RA and OP/BMD are possibly related to secondary effects such as antirheumatic treatment and reduced physical activity.
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Affiliation(s)
- Ying-Qi Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yong Liu
- Center for System Biology, Data Sciences, and Reproductive Health, School of Basic Medical Science, Central South University, Changsha 410011, China
| | - Zhuo-Yuan Chen
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Hui Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Tao Xiao
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, China
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Ashok Kumar D, Anburajan M, Snekhalatha U. Evaluation of low bone mass and prediction of fracture risk using metacarpal radiogrammetry method: a comparative study with DXA and X-ray phantom. Int J Rheum Dis 2018; 21:1350-1371. [PMID: 29968333 DOI: 10.1111/1756-185x.13326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Devaraj Ashok Kumar
- Department of Biomedical Engineering; SRM Institute of Science and Technology; Chennai Tamil Nadu India
| | | | - Umapathy Snekhalatha
- Department of Biomedical Engineering; SRM Institute of Science and Technology; Chennai Tamil Nadu India
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Ahmad HA, Alemao E, Guo Z, Iannaccone CK, Frits ML, Weinblatt M, Shadick NA. Association of Low Bone Mineral Density with Anti-Citrullinated Protein Antibody Positivity and Disease Activity in Established Rheumatoid Arthritis: Findings from a US Observational Cohort. Adv Ther 2018; 35:232-242. [PMID: 29368271 PMCID: PMC5818577 DOI: 10.1007/s12325-017-0657-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Indexed: 01/01/2023]
Abstract
Introduction To assess the relationship between low bone mineral density (BMD), anti-cyclic citrullinated peptide-2 (anti-CCP2) antibodies, and disease activity in patients with established rheumatoid arthritis (RA). Methods Patients enrolled in a single-center, observational cohort registry of patients with RA. Eligible patients had known BMD, as measured by digital X-ray radiogrammetry (DXR–BMD), and anti-CCP2 antibody measurements at the same time point or within 6 months. Anti-CCP2–immunoglobulin (Ig)G-positive (+) patients (≥ 20 U/mL) were distributed into three equal groups (Gp1–3), representing increasing anti-CCP2 antibody concentrations. Associations between BMD and anti-CCP2 antibody status and titer were explored in multivariate regression analyses controlling for covariates (including age, duration of RA, use of steroids, use of osteoporosis medication). Association between disease activity (DAS28 [CRP] < 2.6) and bone loss was also explored. Results A total of 149 patients (all women) were included (47 anti-CCP2 antibody negative [−], 102 anti-CCP2+ [34\titer group]). Mean disease duration was greater in the three anti-CCP2+ groups vs. the anti-CCP2− group. DXR–BMD was lower in the anti-CCP2+ vs. the anti-CCP2− groups (Gp1–3 vs. anti-CCP2−: P < 0.0001 for left and right hands). DXR–BMD decreased with increasing anti-CCP2 titer (P < 0.001 for left and right hands). Patients with low DXR–BMD were less likely to have a DAS28 (CRP) < 2.6 (P = 0.0181). Conclusion Among patients with established RA, data suggest that anti-CCP2+ patients, particularly those with high anti-CCP2 antibody titers, have lower hand BMD, and patients with lower hand BMD are less likely to have low disease activity. Funding Bristol-Myers Squibb. Trial Registration Clinicaltrials.gov identifier, NCT01793103. Electronic supplementary material The online version of this article (10.1007/s12325-017-0657-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Evo Alemao
- Bristol-Myers Squibb, Princeton, NJ, USA
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Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Bak KH, Chun HJ. Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis. Osteoporos Int 2017; 28:1931-1938. [PMID: 28255666 DOI: 10.1007/s00198-017-3972-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/14/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Osteopenia and osteoporosis were independent predictive factors for higher atlantoaxial subluxation occurrence in patients with lower body mass index. Our findings suggest that patients with rheumatoid arthritis with osteopenia or osteoporosis, particularly those with lower body mass index (BMI), should be screened regularly to determine the status of their cervical spines. INTRODUCTION Cervical spine involvement in rheumatoid arthritis (RA) patients may cause serious adverse effects on quality of life and overall health. This study aimed to evaluate the association between atlantodental interval (ADI), atlantoaxial subluxation (AAS), and systemic bone mineral density (BMD) based on BMI variations among established patients with RA. METHODS The ADI was transformed to the natural log scale to normalize distributions for all analyses. Multivariable linear regression analyses were used to identify independent predictive factors for ADI based on each BMD classification. Multivariate Cox regression analyses were also performed to identify independent predictive factors for the risk of AAS, which were classified by tertile groups of BMI. RESULTS A total of 1220 patients with RA who had undergone at least one or more cervical radiography and BMD assessments were identified and enrolled. We found that the association between BMD and ADI (β, -0.029; 95% CI, -0.059 to 0.002; p = 0.070) fell short of achieving statistical significance. However, the ADI showed a 3.6% decrease per 1 BMI increase in the osteoporosis group (β, -0.036; 95% CI, -0.061 to -0.011; p = 0.004). The osteopenia and osteoporosis groups showed about a 1.5-fold and a 1.8-fold increased risk of AAS occurrence among the first tertile of the BMI group. CONCLUSIONS Our study showed a possible association between lower BMD and AAS occurrence in patients with RA with lower BMI. Further studies are needed to confirm our findings.
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Affiliation(s)
- M H Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - J I Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea.
| | - C H Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - J M Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - J H Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - K H Bak
- Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, South Korea
| | - H J Chun
- Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, South Korea
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Pfeil A, Haugeberg G, Renz DM, Reinhardt L, Jung C, Franz M, Wolf G, Böttcher J. Digital X-ray radiogrammetry and its sensitivity and specificity for the identification of rheumatoid arthritis-related cortical hand bone loss. J Bone Miner Metab 2017; 35:192-198. [PMID: 26979320 DOI: 10.1007/s00774-016-0741-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/22/2016] [Indexed: 01/01/2023]
Abstract
Digital X-ray radiogrammetry (DXR) is a computer-assisted diagnosis technique for quantifying cortical hand bone mineral density (BMD) as well as the metacarpal index (MCI) in the metacarpal bones from radiographs. The objective was to compare DXR-BMD and DXR-MCI between healthy individuals and patients with rheumatoid arthritis (RA) and verify the sensitivity and specificity of this technique for the identification of cortical hand bone loss as an additional diagnostic approach in RA. 618 patients were enrolled and divided into two groups: those with RA (n = 309) and a healthy control group (n = 309) as a reference database. DXR-BMD and the DXR-MCI were measured by DXR using hand radiographs. The severity of RA was evaluated by the modified Larsen score. Mean values for DXR-BMD and DXR-MCI in RA patients were significantly lower compared to healthy subjects (-20.7 and -21.1 %, respectively). Depending on the severity of RA-related joint damage, DXR-BMD revealed a significant reduction of -28.1 % and DXR-MCI -28.2 %, comparing score 1 and score 5 of the modified Larsen score. Both DXR-BMD and DXR-MCI had a high sensitivity (DXR-BMD 91 %, DXR-MCI 87 %) and a moderate specificity (DXR-BMD 47 %, DXR-MCI 49 %) to identify RA-related cortical hand bone loss. The DXR technique seems to be able to quantify RA-related periarticular bone loss as a characteristic feature in the course of RA. Consequently, periarticular osteoporosis seems to function as a reliable diagnostic approach comparable to erosions and joint space narrowing in the diagnosis of RA and as a surrogate marker for the progression of bone loss in RA.
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Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany.
| | - Glenn Haugeberg
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Diane M Renz
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Lisa Reinhardt
- Department of Internal Medicine III, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Christian Jung
- Department of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Joachim Böttcher
- Institute of Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Straße des Friedens 122, 07548, Gera, Germany
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7
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Bone health of patients with juvenile idiopathic arthritis: a comparison between dual-energy X-ray absorptiometry and digital X-ray radiogrammetry. Eur J Radiol 2015; 84:1999-2003. [DOI: 10.1016/j.ejrad.2015.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 06/03/2015] [Accepted: 06/16/2015] [Indexed: 01/01/2023]
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8
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Alioglu K, Dogu B, Sirzai H, Yilmaz F, Kuran B. Hand bone mineral density reference values in a Turkish healthy female population. Int J Rheum Dis 2013; 20:1965-1972. [DOI: 10.1111/1756-185x.12159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Kenan Alioglu
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Beril Dogu
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Hulya Sirzai
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Figen Yilmaz
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Banu Kuran
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
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Tatoń G, Rokita E, Wróbel A. Application of geometrical measurements in the assessment of vertebral strength. Pol J Radiol 2013; 78:15-8. [PMID: 23807879 PMCID: PMC3693831 DOI: 10.12659/pjr.883942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 03/27/2013] [Indexed: 11/11/2022] Open
Abstract
Background: The study was aimed at the development of parameters that could be used as predictors of vertebral strength. Proposed parameters describing vertebral geometry and/or shape can be established on the basis of routine spine roentgenograms, making roentgenography a novel tool for vertebral fracture risk assessment in the future. Material/Methods: 20 human cadaveric L3 vertebrae were included in the study. Dual-energy X-ray absorptiometry (DXA) was used for an assessment of bone mineral density (BMD). Quantitative computed tomography (QCT) was performed to measure the volumetric bone density as the most reliable parameter in vertebral fracture risk assessment. Geometrical measurements were performed on the basis of high quality and high resolution computer tomography 3-dimensional images. Biomechanical tests were performed to measure vertebral strength. Two parameters were defined on the basis of extensive research: the ratio between vertebral base area and its height (A/H), and the ratio of vertebral coronal width to coronal height (W/H). Correlations between vertebral mechanical strength – its BMD, QCT density, A/H and W/H were calculated. Results: The best correlation to bone durability was achieved for QCT density (r=0.882), while correlation strength for BMD (r=0.779) and A/H (r=–0.773) were comparable. W/H correlated better than BMD to mechanical strength (–0.788). Conclusions: Geometrical parameters of vertebrae potentially measured on spine radiograms could be used as predictors of vertebral durability. The calculated correlation coefficients suggest that one of the proposed parameters works better than the commonly used BMD.
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Affiliation(s)
- Grzegorz Tatoń
- Department of Biophysics, Jagiellonian University Medical College, Cracow, Poland
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Lunt M. Introduction to statistical modelling 2: categorical variables and interactions in linear regression. Rheumatology (Oxford) 2013; 54:1141-4. [DOI: 10.1093/rheumatology/ket172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Indexed: 11/13/2022] Open
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Lunt M. Introduction to statistical modelling: linear regression. Rheumatology (Oxford) 2013; 54:1137-40. [PMID: 23594471 DOI: 10.1093/rheumatology/ket146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Indexed: 11/14/2022] Open
Abstract
In many studies we wish to assess how a range of variables are associated with a particular outcome and also determine the strength of such relationships so that we can begin to understand how these factors relate to each other at a population level. Ultimately, we may also be interested in predicting the outcome from a series of predictive factors available at, say, a routine clinic visit. In a recent article in Rheumatology, Desai et al. did precisely that when they studied the prediction of hip and spine BMD from hand BMD and various demographic, lifestyle, disease and therapy variables in patients with RA. This article aims to introduce the statistical methodology that can be used in such a situation and explain the meaning of some of the terms employed. It will also outline some common pitfalls encountered when performing such analyses.
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Affiliation(s)
- Mark Lunt
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
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Abstract
PURPOSE OF REVIEW Tumor necrosis factor (TNF) inhibitors are effective for achieving disease control in several inflammatory diseases. Although anti-TNF agents can inhibit bone loss in vitro, their role in the prevention of clinically relevant outcomes such as osteoporosis and fractures has not been clearly established. RECENT FINDINGS There are many studies of the effects of TNF inhibitors on markers of bone turnover; however, few have measured bone mineral density (BMD) or fractures. Most of these studies have small sample sizes and a minority had a placebo control group. Overall these studies suggest that the antiresorptive effects of anti-TNF therapy are related to control of disease activity. SUMMARY The antiresorptive effects of TNF inhibitors are likely related to their anti-inflammatory properties. Studies to date have not demonstrated any advantages of TNF inhibitors over traditional nonbiologic therapies in the prevention of bone loss and fractures.
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Zhu TY, Griffith JF, Qin L, Hung VWY, Fong TN, Kwok AW, Leung PC, Li EK, Tam LS. Bone density and microarchitecture: relationship between hand, peripheral, and axial skeletal sites assessed by HR-pQCT and DXA in rheumatoid arthritis. Calcif Tissue Int 2012; 91:343-55. [PMID: 22945690 DOI: 10.1007/s00223-012-9644-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/02/2012] [Indexed: 12/14/2022]
Abstract
We assessed the relationship of bone density and microarchitecture between hand, peripheral, and axial skeletal sites using high-resolution peripheral quantitative computed tomography (HR-pQCT) and dual-energy X-ray absorptiometry (DXA) in patients with rheumatoid arthritis (RA) and which factors influence these parameters. This was a cross-sectional study of 100 female patients (53.4 ± 9.3 years) with RA. HR-pQCT scans at distal radius and the second metacarpal head were performed to assess cortical and trabecular volumetric bone mineral density (vBMD) and microarchitecture. DXA scans at the hip, lumbar spine, and ultradistal radius were performed to assess areal BMD. There was significant correlation in vBMD and microarchitectural parameters between the second metacarpal head and distal radius (r = 0.201-0.628). Areal BMD at the axial skeleton was moderately associated with vBMD at the peripheral sites (r = 0.354-0.558). Factors related to disease severity/chronicity significantly correlated with vBMD and microarchitecture at the distal radius and the second metacarpal head. Factors related to disease activity were more likely to correlate with vBMD and microarchitecture at the second metacarpal head but not those at the distal radius. HR-pQCT is a promising technique that is capable of providing detailed quantitative assessment of disease-associated periarticular bone loss at both cortical and trabecular bone compartments in patients with RA. Future longitudinal studies will be needed to investigate whether assessment by HR-pQCT can be used as a marker of disease activity and a predictor of disease progression in RA.
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Affiliation(s)
- Tracy Y Zhu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Naumann L, Hermann KGA, Huscher D, Lenz K, Burmester GR, Backhaus M, Buttgereit F. Quantification of periarticular demineralization and synovialitis of the hand in rheumatoid arthritis patients. Osteoporos Int 2012; 23:2671-9. [PMID: 22349908 DOI: 10.1007/s00198-012-1897-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 12/06/2011] [Indexed: 12/14/2022]
Abstract
UNLABELLED The bone mineral density (BMD) measurement of the hand in rheumatoid arthritis (RA) patients is no standard measurement method as yet. The aim was to contribute to the standardization of the hand BMD measurement, especially of periarticular regions. As results, we found best precision values for the wrist and a significant correlation between hand and spine/femur BMD depending on disease activity and disease duration. INTRODUCTION This study was conducted to investigate (i) the precision of periarticular hand BMD measuring, (ii) the periarticular demineralization of the hand, (iii) the correlation between periarticular hand BMD and spine/femur BMD, and (iv) the correlation of hand BMD to hand synovitis. METHODS A number of 52 RA patients were examined by BMD measurement of the femoral neck, spine, whole hand, metacarpophalangeal (MCP) joints II-V, personal identity profile (PIP) joints II-V, and wrist using dual-energy X-ray absorptiometry (DXA). Synovitis of the hand was examined by ultrasonography and magnetic resonance imaging (MRI). Three subgroups were further analyzed: early RA, established RA with moderate and with high disease activity. Early RA and established RA patients with high disease activity were Followed up after 12 months. RESULTS We found (1) best precision of BMD measurement for the wrist, (2) BMD in RA significantly reduced if compared to normal controls, (3) a highly significant positive correlation between hand and spine/femur BMD and the power of correlation to depend on disease activity and disease duration (high correlation in RA with moderate disease activity and early RA, very high correlation in RA with high disease activity), (4) a negative correlation between hand BMD and hand synovitis in RA with high disease activity, and (5) a significant reduction of synovitis but no change in hand BMD after 12 months, respectively. CONCLUSIONS This study shows a highly significant correlation between hand BMD and spine/femur BMD in RA patients depending on disease activity and disease duration. We conclude to measure BMD at different sites including hands in order to quantify bone loss in RA patients most properly.
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Affiliation(s)
- L Naumann
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Pfeil A, Haugeberg G, Hansch A, Renz DM, Lehmann G, Malich A, Wolf G, Böttcher J. Value of digital X-ray radiogrammetry in the assessment of inflammatory bone loss in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2011; 63:666-74. [DOI: 10.1002/acr.20423] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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17
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Iannaccone CK, Lee YC, Cui J, Frits ML, Glass RJ, Plenge RM, Solomon DH, Weinblatt ME, Shadick NA. Using genetic and clinical data to understand response to disease-modifying anti-rheumatic drug therapy: data from the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study. Rheumatology (Oxford) 2010; 50:40-6. [PMID: 20847201 DOI: 10.1093/rheumatology/keq263] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The objective of this review is to report on the progress of the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS) Registry data collection and summarize previous research in understanding therapeutic response to DMARDs using clinical and genetic data. The BRASS Registry, established in 2003, is a large, single-centre, prospective and observational cohort of 1100 RA patients. Patients with either new-onset or established RA disease are recruited from the practices of rheumatologists. Annual visits collect information on demographics, 28-joint DAS-CRP3 (DAS-28-CRP3), medication use, comorbidities and functional status (Modified Health Assessment Questionnaire, Short Form Health Survey 12). Two published studies have utilized BRASS to examine genetic predictors of treatment response. In a cross-sectional study, examining the association between candidate single nucleotide polymorphisms (SNPs) and disease activity in a subset of 120 RA patients on MTX monotherapy, the minor allele of ATIC rs4673993 was associated with low disease activity (P=0.01, DAS-28-CRP3≤3.2). In an international collaboration, 55 BRASS patients receiving anti-TNF therapy were genotyped for 31 SNPs associated with the risk of RA. With our collaborators, we discovered an SNP at the protein tyrosine phosphatase, receptor type, C (PTPRC) gene locus that was associated with EULAR 'good response'. With accurate data collection and the capacity to run genome-wide association studies and SNP analyses, the BRASS Registry has the ability to determine the contribution of genetic variants to disease onset and to assess their usefulness as biomarkers for treatment response and drug toxicity.
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Affiliation(s)
- Christine K Iannaccone
- Department of Medicine, Brigham and Women's Hospital, PBB-B3, 75 Francis Street, Boston, MA 02115, USA.
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Price S. Elucidating the relationship between hand bone loss and osteoporosis. Nat Rev Rheumatol 2010. [DOI: 10.1038/nrrheum.2010.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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