title: Reduced trabecular bone mineral density and cortical thickness accompanied by increased outer bone circumference in metacarpal bone of rheumatoid arthritis patients: a cross-sectional study.
abstract: BACKGROUND
  The objective of this study was to assess three-dimensional bone geometry and density at the epiphysis and shaft of the third meta-carpal bone of rheumatoid arthritis (RA) patients in comparison to healthy controls with the novel method of peripheral quantitative computed tomography (pQCT).
  
  
  METHODS
  PQCT scans were performed in 50 female RA patients and 100 healthy female controls at the distal epiphyses and shafts of the third metacarpal bone, the radius and the tibia. Reproducibility was determined by coefficient of variation. Bone densitometric and geometric parameters were compared between the two groups and correlated to disease characteristics.
  
  
  RESULTS
  Reproducibility of different pQCT parameters was between 0.7% and 2.5%. RA patients had 12% to 19% lower trabecular bone mineral density (BMD) (P<or=0.001) at the distal epiphyses of radius, tibia and metacarpal bone. At the shafts of these bones RA patients had 7% to 16% thinner cortices (P<or=0.03). Total cross-sectional area (CSA) at the metacarpal bone shaft of patients was larger (between 5% and 7%, P<0.02), and relative cortical area was reduced by 13%. Erosiveness by Ratingen score correlated negatively with trabecular and total BMD at the epiphyses and shaft cortical thickness of all measured bones (P<0.04).
  
  
  CONCLUSIONS
  Reduced trabecular BMD and thinner cortices at peripheral bones, and a greater bone shaft diameter at the metacarpal bone suggest RA specific bone alterations. The proposed pQCT protocol is reliable and allows measuring juxta-articular trabecular BMD and shaft geometry at the metacarpal bone.
authors.affiliation: Department of Rheumatology and Clinical Immunology/Allergology, University Hospital Berne, Freiburgstrasse 18, Bern 3010, Switzerland. daniel.aeberli@insel.ch
authors.forename: Daniel
authors.initials: D
authors.lastname: Aeberli
authors.forename: Prisca
authors.initials: P
authors.lastname: Eser
authors.forename: Harald
authors.initials: H
authors.lastname: Bonel
authors.forename: Jolanda
authors.initials: J
authors.lastname: Widmer
authors.forename: Gion
authors.initials: G
authors.lastname: Caliezi
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Varisco
authors.forename: Burkhard
authors.initials: B
authors.lastname: Möller
authors.forename: Peter M
authors.initials: PM
authors.lastname: Villiger
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000473:pathology* / Q000503:physiopathology*; D015519:Bone Density / Q000502:physiology*; D016022:Case-Control Studies; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D050279:Metacarpal Bones / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D008875:Middle Aged; D011884:Radius / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D015203:Reproducibility of Results; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed