Accelerated hand bone mineral density loss is associated with progressive joint damage in hands and feet in recent-onset rheumatoid arthritis.
BACKGROUND
To investigate whether accelerated hand bone mineral density (BMD) loss is associated with progressive joint damage in hands and feet in the first year of rheumatoid arthritis (RA) and whether it is an independent predictor of subsequent progressive total joint damage after 4 years.


METHODS
In 256 recent-onset RA patients, baseline and 1-year hand BMD was measured in metacarpals 2-4 by digital X-ray radiogrammetry. Joint damage in hands and feet were scored in random order according to the Sharp-van der Heijde method at baseline and yearly up to 4 years.


RESULTS
68% of the patients had accelerated hand BMD loss (>-0.003 g/cm2) in the first year of RA. Hand BMD loss was associated with progressive joint damage after 1 year both in hands and feet with odds ratios (OR) (95% confidence intervals [CI]) of 5.3 (1.3-20.9) and 3.1 (1.0-9.7). In univariate analysis, hand BMD loss in the first year was a predictor of subsequent progressive total joint damage after 4 years with an OR (95% CI) of 3.1 (1.3-7.6). Multivariate analysis showed that only progressive joint damage in the first year and anti-citrullinated protein antibody positivity were independent predictors of long-term progressive joint damage.


CONCLUSIONS
In the first year of RA, accelerated hand BMD loss is associated with progressive joint damage in both hands and feet. Hand BMD loss in the first year of recent-onset RA predicts subsequent progressive total joint damage, however not independent of progressive joint damage in the first year.
Güler-Yüksel
Melek
M
Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. m.yuksel@lumc.nl
Klarenbeek
Naomi B
NB
Goekoop-Ruiterman
Yvonne P M
YP
de Vries-Bouwstra
Jeska K
JK
van der Kooij
Sjoerd M
SM
Gerards
Andreas H
AH
Ronday
H Karel
HK
Huizinga
Tom W J
TW
Dijkmans
Ben A C
BA
Allaart
Cornelia F
CF
Lems
Willem F
WF
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000494:pharmacology / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000503:physiopathology*; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006225:Hand / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D000069285:Infliximab; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D011237:Predictive Value of Tests; D011241:Prednisone / Q000494:pharmacology / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D012460:Sulfasalazine / Q000494:pharmacology / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D012460:Sulfasalazine; D000069285:Infliximab; D011241:Prednisone; D008727:Methotrexate