Periarticular bone structure in rheumatoid arthritis patients and healthy individuals assessed by high-resolution computed tomography.
OBJECTIVE
To define the nature of structural bone changes in patients with rheumatoid arthritis (RA) compared with those in healthy individuals by using the novel technique of high-resolution microfocal computed tomography (micro-CT).


METHODS
Fifty-eight RA patients and 30 healthy individuals underwent a micro-CT scan of the proximal wrist and metacarpophalangeal joints. Bone lesions such as cortical breaks, osteophytes, and surface changes were quantified on 2-dimensional (2-D) slices as well as by using 3-D reconstruction images, and exact localization of lesions was recorded.


RESULTS
Micro-CT scans could detect bone lesions <0.5 mm in width or depth. Small erosions could be observed in healthy individuals and RA patients, whereas lesions >1.9 mm in diameter were highly specific for RA. Cortical breaks were mostly found along the radial sites of the metacarpal heads. No significant difference in the presence of osteophytes between healthy individuals and RA patients was found. Cortical surface changes, presumably cortical thinning and fenestration, became evident from 3-D reconstructions and were more pronounced in RA patients.


CONCLUSIONS
Micro-CT allows exact detection of morphologic changes of juxtaarticular bone in healthy individuals and RA patients. Even healthy individuals occasionally show bone changes, but the severity of these lesions, with the exception of osteophytes, is greater in RA patients. Thus, micro-CT allows accurate differentiation among physiologic bone changes in joints and among types of pathologic bone damage resulting from RA.
Stach
Christian M
CM
University of Erlangen-Nuremberg, Erlangen, Germany.
Bäuerle
Michael
M
Englbrecht
Matthias
M
Kronke
Gerhard
G
Engelke
Klaus
K
Manger
Bernhard
B
Schett
Georg
G
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging; D008875:Middle Aged; D054850:Osteophyte / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014955:Wrist Joint / Q000000981:diagnostic imaging; D055114:X-Ray Microtomography / Q000379:methods* / Q000592:standards*