Abstract
Small cortical interruptions may be the first sign of an erosion, and more interruptions can be found in patients with rheumatoid arthritis (RA) compared with healthy subjects. First, we compared the number and size of interruptions in patients with RA with healthy subjects using high-resolution peripheral quantitative CT (HR-pQCT). Second, we investigated the association between structural damage and inflammatory markers on conventional radiography (CR) and MRI with interruptions on HR-pQCT. Third, the added value of HR-pQCT over CR and MRI was investigated. The finger joints of 39 patients with RA and 38 healthy subjects were examined through CR, MRI, and HR-pQCT. CRs were scored using the Sharp/Van der Heijde method. MRI images were analyzed for the presence of erosions, bone marrow edema, and synovitis. HR-pQCT images were analyzed for the number, surface area, and volume of interruptions using a semiautomated algorithm. Descriptives were calculated and associations were tested using generalized estimating equations. Significantly more interruptions and both a larger surface area and the volume of interruptions were detected in the metacarpophalangeal joints of patients with RA compared with healthy subjects (median, 2.0, 1.42 mm2 , and 0.48 mm3 versus 1.0, 0.69 mm2 , and 0.23 mm3 , respectively; all p < 0.01). Findings on CR and MRI were significantly associated with more and larger interruptions on HR-pQCT (prevalence ratios [PRs] ranging from 1.03 to 7.74; all p < 0.01) in all subjects, and were consistent in patients with RA alone. Having RA was significantly associated with more and larger interruptions on HR-pQCT (PRs, 2.33 to 5.39; all p < 0.01), also after adjustment for findings on CR or MRI. More and larger cortical interruptions were found in the finger joints of patients with RA versus healthy subjects, also after adjustment for findings on CR or MRI, implying that HR-pQCT imaging may be of value in addition to CR and MRI for the evaluation of structural damage in patients with RA. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease, in which inflammation at the joint may lead to periarticular osteoporosis and erosions.(1,2) Traditionally, the presence of erosions is assessed by conventional radiography (CR) in the joints of the hands and feet
CR is limited by its sensitivity in the detection of erosions, which is low compared with CT and MRI.[3,4,5,6] With CT as a reference method, sensitivity to detect erosions in metacarpophalangeal (MCP) joints was 26% and 68% for CR and MRI, respectively.[7]. In addition, MRI is able to visualize inflammation in the joint, such as bone marrow edema (BME) and synovitis, which are associated with the progression of bone damage on CR in patients with RA.[8,9,10]
Major drawbacks to the visual detection of cortical interruptions are that it is prone to subjectivity and is time-consuming.[27]. In a previous study, we showed that the interoperator reliability of visually detecting these small cortical interruptions was fair.[28] we developed and validated a semiautomated algorithm that more reliably detects the number, surface area, and volume of cortical interruptions in comparison with visual scoring.[28,29,30,31]
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease, in which inflammation at the joint may lead to periarticular osteoporosis and erosions (ie, pathological cortical interruptions).(1,2) Traditionally, the presence of erosions is assessed by conventional radiography (CR) in the joints of the hands and feet. Major drawbacks to the visual detection of cortical interruptions are that it is prone to subjectivity and is time-consuming.[27] In a previous study, we showed that the interoperator reliability of visually detecting these small cortical interruptions was fair.[28] we developed and validated a semiautomated algorithm that more reliably detects the number, surface area, and volume of (small) cortical interruptions (diameter !0.41 mm) in comparison with visual scoring.[28,29,30,31] These earlier studies demonstrated the feasibility, validity, and reliability of our semiautomated algorithm in quantifying (small) cortical interruptions, it remains unknown if these (small) cortical interruptions are more frequently seen in patients with RA compared with controls, and whether they are related to both structural damage on CR and structural damage and inflammatory markers on MRI. We investigated the bone density and microstructure parameters in all subjects and in patients with RA alone, and their association with the cortical interruption parameters
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