title: Hand bone densitometry: a more sensitive standard for the assessment of early bone damage in rheumatoid arthritis.
abstract: OBJECTIVE
  To examine the role of hand dual-energy x ray absorptiometry (DEXA) compared with radiography in the assessment of bone involvement in patients with early rheumatoid arthritis (RA) who have active disease.
  
  
  METHODS
  The study population (n = 79) had RA of <12 months' duration and were selected for poor prognostic features. Clinical data and bone mineral density (BMD) data were collected at baseline, 24 and 48 weeks. Hand radiographs were performed at baseline and 48 weeks. Bone damage analyses were performed for the group and individuals using the smallest detectable change (SDC) method.
  
  
  RESULTS
  At baseline, mean disease duration was 8.5 months, erythrocyte sedimentation rate was 34.3 mm/hour, C-reactive protein was 40.2 mg/l, Health Assessment Questionnaire score was 1.35 and 81% of patients were positive for rheumatoid factor. Mean (95% CI) hand BMD loss was 2.5% (-3.5 to -1.5) at 24 weeks and 2.6% (-3.8 to -1.5) at 48 weeks. Individual hand bone loss exceeding the SDC was seen in 46.8% at 24 weeks and in 58.2% at 48 weeks. In the subgroup of 58 patients who had undergone radiography, radiographic joint damage score evaluated by the Sharp-van der Heijde method increased from 4.8 to 10.6 (p = 0.001). Individual hand bone loss in this subgroup exceeding the SDC was seen in 50.0% at 24 weeks and in 56.9% at 48 weeks, whereas at 48 weeks only 22.4% had deteriorated in modified Sharp score.
  
  
  CONCLUSIONS
  The study results indicate that hand DEXA is a more sensitive tool than radiology (radiographic joint-damage scores), for measuring disease-related bone damage in early RA.
authors.affiliation: Department of Rheumatology Sørlandet Hospital, Kristiansand, Norway.
authors.forename: Glenn
authors.initials: G
authors.lastname: Haugeberg
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Green
authors.forename: Philip G
authors.initials: PG
authors.lastname: Conaghan
authors.forename: Mark
authors.initials: M
authors.lastname: Quinn
authors.forename: Richard
authors.initials: R
authors.lastname: Wakefield
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Proudman
authors.forename: Sheena
authors.initials: S
authors.lastname: Stewart
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hensor
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D015519:Bone Density; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D005500:Follow-Up Studies; D050276:Hand Bones / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D011379:Prognosis; D015203:Reproducibility of Results