title: Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study.
abstract: OBJECTIVE
  To assess whether in early (rheumatoid) arthritis (RA) patients, metacarpal bone mineral density (BMD) loss after 4 months predicts radiological progression after 1 year of antirheumatic treatment.
  
  
  METHODS
  Metacarpal BMD was measured 4 monthly during the first year by digital X-ray radiogrammetry (DXR-BMD) in patients participating in the IMPROVED study, a clinical trial in 610 patients with recent onset RA (2010 criteria) or undifferentiated arthritis, treated according to a remission (disease activity score<1.6) steered strategy. With Sharp/van der Heijde progression ≥0.5 points after 1 year (yes/no) as dependent variable, univariate and multivariate logistic regression analyses were performed.
  
  
  RESULTS
  Of 428 patients with DXR-BMD results and progression scores available, 28 (7%) had radiological progression after 1 year. Independent predictors for radiological progression were presence of baseline erosions (OR (95% CI) 6.5 (1.7 to 25)) and early DXR-BMD loss (OR (95% CI) 1.5 (1.1 to 2.0)). In 366 (86%) patients without baseline erosions, early DXR-BMD loss was the only independent predictor of progression (OR (95% CI) 2.0 (1.4 to 2.9)).
  
  
  CONCLUSIONS
  In early RA patients, metacarpal BMD loss after 4 months of treatment is an independent predictor of radiological progression after 1 year. In patients without baseline erosions, early metacarpal BMD loss is the main predictor of radiological progression.
authors.affiliation: Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands.
authors.forename: K V C
authors.initials: KV
authors.lastname: Wevers-de Boer
authors.affiliation: Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Heimans
authors.affiliation: Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Visser
authors.affiliation: Sectra, Linköping, Sweden CMIV Linköping University, Linköping, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Kälvesten
authors.affiliation: Department of Rheumatology, Haga Hospital, The Hague, Zuid-holland, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Goekoop
authors.affiliation: Department of Rheumatology, Groene Hart Hospital, Gouda, Zuid-holland, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Oosterhout
authors.affiliation: Department of Rheumatology, Franciscus Hospital, Roosendaal, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Harbers
authors.affiliation: Department of Rheumatology, Reinier de Graaf Gasthuis, Delft, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Bijkerk
authors.affiliation: Bronovo Hospital, The Hague, Zuid-holland, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Steup-Beekman
authors.affiliation: Department of Rheumatology, MCH, The Hague, Zuid-holland, The Netherlands.
authors.forename: M P D M
authors.initials: MP
authors.lastname: de Buck
authors.affiliation: Oosterschelde Hospital, Goes, The Netherlands.
authors.forename: P B J
authors.initials: PB
authors.lastname: de Sonnaville
authors.affiliation: Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands.
authors.forename: T W J
authors.initials: TW
authors.lastname: Huizinga
authors.affiliation: Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands.
authors.forename: C F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D015502:Absorptiometry, Photon; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D015519:Bone Density; D018450:Disease Progression; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012460:Sulfasalazine / Q000627:therapeutic use
chemical_list: D018501:Antirheumatic Agents; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D011241:Prednisone; D008727:Methotrexate
keywords: Bone Mineral Density; Early Rheumatoid Arthritis; Outcomes research