Bone erosion in the 2nd metacarpophalangeal head: association with its bone mineral density by HR-pQCT in rheumatoid arthritis patients

Camille P Figueiredo,Ana Cristina Medeiros,Lucas Peixoto Sales,Rosa M R Pereira,Valeria F Caparbo,Mariana O Perez

doi:10.1186/s12891-021-03992-5

Abstract

BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disease depicted by synovial inflammation leading to local and systemic bone loss. The aim of this study was to evaluate by a HR-pQCT (High Resolution Peripheral Quantitative Computed Tomography) study which parameters are associated with volume of bone erosions including bone mineral density (BMD) around erosions (VOI 1 to 4 = volume of interest), BMD of metacarpophalangeal (MCP) head, BMD of radius, presence of osteophytes and joint space width (JSW).MethodsFifty female RA patients (18–50 years) were enrolled in this study. Demographic and disease-specific data, laboratory inflammatory parameters and handgrip test were performed. All patients underwent HR-pQCT of 2nd and 3rd MCP joints and distal radius, according to established protocols. The volume of bone erosions was evaluated by MIAF (Medical Image Analysis Framework) software. Osteophytes were analyzed by manual method.ResultsThe mean of age and disease duration were 40.0 ± 6.0 yrs. and 10.8 ± 4.8 yrs., respectively. According to DAS-28 (Disease Activity Score), 54% (27) of the sample were in remission. However, when SDAI (Simplified Disease Activity Index) was used, only 18% (9) were under remission. The mean of HAQ (Health Assessment Questionnaire), ESR (Erythrocyte sedimentation rate) and CRP (C reactive protein) were 0.9 ± 0.7, 13.9 ± 12.2 mm and 5.6 ± 7.5 mg/mL, respectively. Forty-six bone erosions (0.9 ± 1.2 erosion/patient) and 14 osteophytes (0.3 ± 0.7 osteophyte/patient) were found in 2nd MCP head. The median (IQR-Interquartile range) of volume of erosion and volume of osteophytes were 14.9 (5.7;35.9)mm3 and 3.1 (2.1, 4.3)mm3, respectively. The mean of JSW was 80.5 ± 34.2 mm3. The volume of bone erosions was negatively correlated with BMD of 2nd MCP head, VOI-4 and JSW; and it was positively correlated with osteophytes number. Regarding absence or presence of erosion in 2nd MCP head, a significant difference was found between BMD of MCP head, osteophyte number and JSW. Multiple linear regression analysis showed that only BMD of 2nd MCP head was independently associated with volume of bone erosions.ConclusionBMD of MCP head was independently associated with volume of bone erosion, suggesting that this parameter should be used to analyze and monitoring bone destruction, as well as to evaluate treatment response in RA patients.

Highlights

Rheumatoid arthritis (RA) is a chronic autoimmune disease depicted by synovial inflammation leading to local and systemic bone loss
bone mineral density (BMD) of MCP head was independently associated with volume of bone erosion, suggesting that this parameter should be used to analyze and monitoring bone destruction, as well as to evaluate treatment response in RA patients
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent synovial inflammation and bone loss that might lead to progressive joint damage, especially in small joints of hands and feet, deformities and functional disability [1]

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic autoimmune disease depicted by synovial inflammation leading to local and systemic bone loss. Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent synovial inflammation and bone loss that might lead to progressive joint damage, especially in small joints of hands and feet, deformities and functional disability [1]. During early stages of RA, the disease gradually develops joint swelling, stiffness and pain, besides that patients often have a history of long timing symptoms when first presenting to a rheumatologist. Periarticular demineralization of metacarpal bones may already be present at this stage, representing an early radiologic manifestation visible on plain radiographs [5, 6], with a closed association to inflammatory activity in RA [7]. Data on quantifying periarticular bone loss in RA patients is not precise when standard techniques are used, as plain radiography [8, 9] or dual- energy X-ray absorptiometry (DXA), restricted to areal bone mineral density (aBMD), validated for femur and spine [10, 11]

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