Metacarpal Index Estimated by Digital X-ray Radiogrammetry as a Tool for Differentiating Rheumatoid Arthritis Related Periarticular Osteopenia

Abstract

To investigate Metacarpal Index (MCI) and Bone Mineral Density (BMD) estimated by Digital X-ray Radiogrammetry (DXR) with respect to its ability to quantify severity-dependent variations of bone mineralisation in patients with early rheumatoid arthritis compared to Dual Energy X-ray Absorptiometry (DXA), 122 patients underwent a prospective analysis of BMD and MCI by DXR, whereas both DXR-parameters were estimated from plain radiographs of the non-dominant hand. In comparison DXA measured BMD on total femur and lumbar spine (L2-L4). Additionally Steinbrocker Stage was assessed to differentiate the severity of rheumatoid arthritis (RA). Disease activity of RA was estimated by C-reactive Protein (CRP; in mg/l), Erythrocyte Sedimentation Rate (ESR in mm/1st hour) and by the disease activity score with 28-joint count (DAS 28). In consequence, The DXR-parameters, in particular DXR-MCI, revealed significant associations to age, Body Mass Index, CRP, DAS 28 and Steinbrocker graduation; no significant associations could be verified between DXA-parameters and all characteristics of disease activity and severity of RA. The highest correlation was found between DXR-MCI and DXR-BMD with R= 0.89 (independent from severity of RA). In all patients DXR-MCI significantly decreased (-14.3%) from 0.42 ± 0.09 (stage 1) to 0.36 ± 0.07 (stage 2) dependent on severity of RA. The comparable relative reduction of DXR-BMD was -11.1%. The group of patients with minor disease activity (DAS 28 > 5.1) showed a significant flattened reduction (-11.4%) for DXR-MCI from 0.44 ± 0.08 (stage 1) to 0.39 ± 0.08 (stage 2). For accentuated disease activity (DAS 28 > 5.1) the DXR-MCI revealed a pronounced reduction (-23.1 %). No significant declines were observed for DXA-BMD of the lumbar spine and total femur in all patients as well as dependent on disease activity. Conclusion: DXR can exactly quantify cortical thinning of the metacarpal bones and can identify cortical demineralisation in patients suffering from early rheumatoid arthritis surpassing DXA-measurements at axial bone sites. In this context DXR-MCI seems to be the most sensitive parameter for differentiation of patients with minor or accentuated disease activity following severity-dependent cortical bone loss. Keywords: digital X–ray radiogrammetry; dual energy X-ray absorptiometry; metacarpal index; bone mineral density; rheumatoid arthritis; steinbrocker stage