Early Metacarpal Bone Mineral Density Loss Using Digital X-Ray Radiogrammetry and 3-Tesla Wrist MRI in Established Rheumatoid Arthritis: A Longitudinal One-Year Observational Study

Arthritis, Feb 2015

Objectives. Early change in rheumatoid arthritis (RA) is characterised by periarticular osteopenia. We investigated the relationship of early metacarpal digital X-ray radiogrammetry bone mineral density (DXR-BMD) change rate (RC-BMD, mg/cm2/month) to longitudinal changes in hand and feet radiographic and wrist MRI scores over 1 year. Materials and Methods. 10 RA patients completed the study and had wrist 3T-MRI and hand and feet X-rays at various time points over 1 year. MRI was scored by RAMRIS, X-ray was done by van der Heijde modified Sharp scoring, and RC-BMD was analysed using dxr-online. Results. There was good correlation amongst the two scorers for MRI measures and ICC for erosions: 0.984, BME: 0.943, and synovitis: 0.657. Strong relationships were observed between RC-BMD at 12-week and 1-year change in wrist marrow oedema (BME) (, ) but not with erosion, synovitis, or radiographic scores. Conclusion. Early RC-BMD correlates with 1-year wrist BME change, which is a known predictor of future erosion and joint damage. However, in our pilot study, early RC-BMD did not show relationships to MRI erosion or radiographic changes over 1 year. This may reflect a slower kinetic in the appearance of MRI/radiographic erosions, generating the hypothesis that RC-BMD may be a more sensitive and early structural prognostic marker in RA follow-up.

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Early Metacarpal Bone Mineral Density Loss Using Digital X-Ray Radiogrammetry and 3-Tesla Wrist MRI in Established Rheumatoid Arthritis: A Longitudinal One-Year Observational Study

Early Metacarpal Bone Mineral Density Loss Using Digital X-Ray Radiogrammetry and 3-Tesla Wrist MRI in Established Rheumatoid Arthritis: A Longitudinal One-Year Observational Study Anshul Rastogi,1 Jakob Algulin,2 Pamela Mangat,3 Adrian K. P. Lim,4 Keshthra Satchithananda,5 Joseph V. Hajnal,6 and Peter C. Taylor7 1Joint Department of Medical Imaging, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada M5G 1X5 2SECTRA Imtec AB, Teknikringen 20, 583 30 Linkoping, Sweden 3Department of Rheumatology, Royal Free Hospital, Pond Street, London NW3 2GQ, UK 4Department of Radiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK 5Department of Radiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK 6Division of Imaging Sciences, King’s College London, The Rayne Institute, 3rd Floor, Lambeth Wing, St. Thomas’ Hospital, London SE1 7EH, UK 7Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK Received 14 August 2014; Revised 13 January 2015; Accepted 13 January 2015 Academic Editor: Marco Amedeo Cimmino Copyright © 2015 Anshul Rastogi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objectives. Early change in rheumatoid arthritis (RA) is characterised by periarticular osteopenia. We investigated the relationship of early metacarpal digital X-ray radiogrammetry bone mineral density (DXR-BMD) change rate (RC-BMD, mg/cm2/month) to longitudinal changes in hand and feet radiographic and wrist MRI scores over 1 year. Materials and Methods. 10 RA patients completed the study and had wrist 3T-MRI and hand and feet X-rays at various time points over 1 year. MRI was scored by RAMRIS, X-ray was done by van der Heijde modified Sharp scoring, and RC-BMD was analysed using dxr-online. Results. There was good correlation amongst the two scorers for MRI measures and ICC for erosions: 0.984, BME: 0.943, and synovitis: 0.657. Strong relationships were observed between RC-BMD at 12-week and 1-year change in wrist marrow oedema (BME) (, ) but not with erosion, synovitis, or radiographic scores. Conclusion. Early RC-BMD correlates with 1-year wrist BME change, which is a known predictor of future erosion and joint damage. However, in our pilot study, early RC-BMD did not show relationships to MRI erosion or radiographic changes over 1 year. This may reflect a slower kinetic in the appearance of MRI/radiographic erosions, generating the hypothesis that RC-BMD may be a more sensitive and early structural prognostic marker in RA follow-up. 1. Introduction Radiographic imaging (X-ray) has traditionally been important in diagnosis, as per 1987 American College of Rheumatology (ACR) criteria [1] and subsequent evaluation of patients with rheumatoid arthritis (RA) [2–4]. Evaluation of the extent and rate of structural damage in routine clinical practice involves hand and feet radiographs [5, 6] and the findings may inform treatment change and optimisation. An early radiographic change in RA is periarticular osteopenia [7]. Early bone mineral density loss is a predictor of differentiation to RA in undifferentiated arthritis [8] and also predicts future joint damage in RA [9]. Plain radiographs have the limitation that they do not assess synovitis and bone marrow oedema (BME) [10]. It is known that BME is an early disease activity measure that predicts future erosions [11]. The time and costs involved in having repeated MRI as a follow-up imaging modality limits its potential. Radiographs are a cheaper, more readily available, quicker, and routinely performed investigation in clinical practice for RA follow-up. Various X-ray scoring methods have been described to assess joint damage in RA in the context of clinical trials [3]. Rosholm et al. described a new automated radiogrammetric method to assess bone mineral density loss from single hand radiographs [12]. This technique has been used in early RA [9, 13, 14]. To date, few studies have compared this method with MRI disease activity change over time [15–17]. In this study, we evaluated the relationship between automated early metacarpal bone mineral density loss, disease activity using high field strength 3T wrist MRI, and hand and feet radiographic scores over a year in patients with established RA undergoing standard clinical care. 2. Material and Methods2.1. Patients The study was approved by local research ethics committee (reference: 06/Q0401/97) and informed written consents were obtained according to the Declaration of Helsinki guidelines. Thirteen rheumatoid arthritis patients, as per 1987 ACR criteria, were enrolled. Ten patients completed study (1 patient withdrew due to claustrop (...truncated)


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Anshul Rastogi, Jakob Algulin, Pamela Mangat, Adrian K. P. Lim, Keshthra Satchithananda, Joseph V. Hajnal, Peter C. Taylor. Early Metacarpal Bone Mineral Density Loss Using Digital X-Ray Radiogrammetry and 3-Tesla Wrist MRI in Established Rheumatoid Arthritis: A Longitudinal One-Year Observational Study, Arthritis, 2015, 2015, DOI: 10.1155/2015/852989