Abstract
ObjectivesThe purpose of the study was to prospectively investigate change (repair or progression) in the number, surface area and volume of cortical interruptions, bone density (vBMD) and micro-structural parameters assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) in finger joints of patients with rheumatoid arthritis (RA) treated with synthetic disease modifying anti-rheumatic drugs (sDMARDs) and/or biologic DMARDs (bDMARDs) over a 1-year follow-up period, and in comparison with healthy subjects (HS).MethodsThirty-two patients with RA (221 joints, 53% on bDMARDs) and 32 HS (117 joints) were assessed at baseline and after 1 year using semi-automatic analysis of HR-pQCT images. Mean changes (group level) and the proportion of joints (joint level) with changes beyond the least significant change were calculated.ResultsAt baseline, 530 interruptions were identified in patients, and 136 in HS. The mean of the interruption parameters did not significantly change in either group Mean vBMD decreased more in patients than in HS (− 4.4 versus − 1.1 mgHA/cm3, respectively). In patients versus HS, proportionally more joints showed repair in interruption volume (6.6% versus 1.7%, respectively) and loss of vBMD (26.7% versus 12.9%, respectively). In patients on sDMARDs versus patients on bDMARDs, proportionally more joints showed progression in the number of interruptions and loss of vBMD (6.1% versus 1.8% and 31.3% versus 17.2%, respectively).ConclusionsHR-pQCT is able to quantify bone repair and progression. Cortical interruption-, vBMD-, and micro-structure were impaired in RA, of which vBMD and micro-structure further deteriorated, particularly in patients on sDMARDs.
Highlights
Materials and MethodsIn rheumatoid arthritis (RA), increased osteoclast activity by disease-specific auto-antibodies and pro-inflammatory cytokines can result in peri-articular bone erosions, loss of bone density, and micro-structure [1, 2].High-resolution peripheral quantitative computed tomography (HR-pQCT) allows in vivo evaluation of the three-dimensional (3D) bone micro-structure with an isotropic voxel size of 82 μm
The present study showed that with semi-automatic HRpQCT image analysis, cortical interruption, volumetric bone mineral density (vBMD)- and micro-structural parameters were impaired in patients with RA compared with healthy subjects (HS), of which vBMD and micro-structural parameters further deteriorated after 1 year
Proportionally more joints of patients on synthetic disease modifying anti-rheumatic drugs (sDMARDs) showed progression in the number of interruptions and loss in vBMD compared with patients on biological disease modifying anti-rheumatic drugs (bDMARDs)
Summary
Materials and MethodsIn rheumatoid arthritis (RA), increased osteoclast activity by disease-specific auto-antibodies and pro-inflammatory cytokines can result in peri-articular bone erosions (i.e., pathological cortical interruptions), loss of bone density, and micro-structure [1, 2].High-resolution peripheral quantitative computed tomography (HR-pQCT) allows in vivo evaluation of the three-dimensional (3D) bone micro-structure with an isotropic voxel size of 82 μm. It has a higher sensitivity to detect erosions than conventional radiography (CR), magnetic resonance imaging (MRI), and computed tomography (CT) [3, 4], and enables to evaluate small cortical interruptions, the volumetric bone mineral density (vBMD), and bone micro-structure in finger joints [5,6,7]. Repair of bone was primarily found in patients treated with biological disease modifying anti-rheumatic drugs (bDMARDs) [8,9,10,11]. These studies mainly focused on the presence and change in size of large, pathological interruptions. Small interruptions might not be specific for RA [13], they might be prone to bone resorption early in the course of RA and can be the first sign of an erosion [1]
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