Abstract
BackgroundTo investigate hand bone loss (HBL) measured by digital X-ray radiogrammetry (DXR) in patients with early rheumatoid arthritis (RA) receiving different treatment regimens, and to evaluate if DXR change rates during the first 12 months correlate with radiological damage after 24 months.MethodsFrom the total SWEFOT trial population, 159 patients had hand radiographs correctly timed and taken with same modality to be analyzed with DXR. All patients started treatment with methotrexate. After 3–4 months, patients with DAS28 > 3.2 were randomized to add sulfasalazine and hydroxychloroquine (triple therapy) or infliximab (MTX + INF). Those with DAS28 ≤3.2 were followed in regular care. Radiographic progression over 24 months was scored according to the Sharp van der Heijde score (SHS) and defined as >5 increase in T-SHS over 24 months. Hand bone mineral density (BMD) was measured by DXR at inclusion and 12 months and a change ≥2.5 mg/cm2/month was used as a cut-off for HBL.ResultsIn the MTX responders, triple therapy, and MTX + INF groups, the proportions with HBL were 4.1%, 22.2% and 16.4%, respectively (p = 0.01), and the mean (SD) radiological progression in these groups was 3.91 (6.72), 7.40 (14.63) and 2.72 (4.55) respectively (p = 0.06). Patients with HBL had significantly greater risk for radiographic progression, compared with patients without HBL (odds ratio 3.09, 95% CI =1.20–7.79, p = 0.02).ConclusionsNon-responders to MTX had a significantly greater risk of HBL than MTX-responders, despite the add-on therapies. Patients with HBL during the 12 months had greater risk of radiographic progression after 24 months. Evaluation of HBL may help to identify patients who are at risk of radiographic progression.
Highlights
To investigate hand bone loss (HBL) measured by digital X-ray radiogrammetry (DXR) in patients with early rheumatoid arthritis (RA) receiving different treatment regimens, and to evaluate if DXR change rates during the first 12 months correlate with radiological damage after 24 months
Chronic synovitis in rheumatoid arthritis (RA) can lead to irreversible joint damage, which is seen on conventional plain radiography [1]
The aim of this study was to determine whether hand bone loss (HBL) analysed with DXR correlated with radiographic progression, as measured by van der Heijde modified Sharp score (SHS) [17] in patients with early RA and to compare HBL and radiographic progression in the three treatment groups of this trial
Summary
To investigate hand bone loss (HBL) measured by digital X-ray radiogrammetry (DXR) in patients with early rheumatoid arthritis (RA) receiving different treatment regimens, and to evaluate if DXR change rates during the first 12 months correlate with radiological damage after 24 months. Measurement of the degree of joint damage represents an important tool to assess disease progression and effectiveness of current treatments [2,3]. Periarticular osteopenia, erosions and joint space narrowing are radiographic features of RA that radiographs of the hands by digital X-ray radiogrammetry (DXR) [5,9,10,11,12,13]. Prior studies have suggested that this new technique has predictive value for RA-related joint damages and radiological progression [7,9,12,13,15]. We present data on hand BMD change measured by DXR based on part of the SWEFOT (SWEdish PharmacOTherapy) early RA trial population [16]
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