title: Early metacarpal bone mineral density loss using digital x-ray radiogrammetry and 3-tesla wrist MRI in established rheumatoid arthritis: a longitudinal one-year observational study.
abstract: Objectives. Early change in rheumatoid arthritis (RA) is characterised by periarticular osteopenia. We investigated the relationship of early metacarpal digital X-ray radiogrammetry bone mineral density (DXR-BMD) change rate (RC-BMD, mg/cm(2)/month) to longitudinal changes in hand and feet radiographic and wrist MRI scores over 1 year. Materials and Methods. 10 RA patients completed the study and had wrist 3T-MRI and hand and feet X-rays at various time points over 1 year. MRI was scored by RAMRIS, X-ray was done by van der Heijde modified Sharp scoring, and RC-BMD was analysed using dxr-online. Results. There was good correlation amongst the two scorers for MRI measures and ICC for erosions: 0.984, BME: 0.943, and synovitis: 0.657. Strong relationships were observed between RC-BMD at 12-week and 1-year change in wrist marrow oedema (BME) (r = 0.78, P = 0.035) but not with erosion, synovitis, or radiographic scores. Conclusion. Early RC-BMD correlates with 1-year wrist BME change, which is a known predictor of future erosion and joint damage. However, in our pilot study, early RC-BMD did not show relationships to MRI erosion or radiographic changes over 1 year. This may reflect a slower kinetic in the appearance of MRI/radiographic erosions, generating the hypothesis that RC-BMD may be a more sensitive and early structural prognostic marker in RA follow-up.
authors.affiliation: Joint Department of Medical Imaging, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada M5G 1X5.
authors.forename: Anshul
authors.identifier: 0000-0001-8461-6539
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: SECTRA Imtec AB, Teknikringen 20, 583 30 Linkoping, Sweden.
authors.forename: Jakob
authors.initials: J
authors.lastname: Algulin
authors.affiliation: Department of Rheumatology, Royal Free Hospital, Pond Street, London NW3 2GQ, UK.
authors.forename: Pamela
authors.initials: P
authors.lastname: Mangat
authors.affiliation: Department of Radiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: Adrian K P
authors.initials: AK
authors.lastname: Lim
authors.affiliation: Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK.
authors.forename: Keshthra
authors.initials: K
authors.lastname: Satchithananda
authors.affiliation: Division of Imaging Sciences, King's College London, The Rayne Institute, 3rd Floor, Lambeth Wing, St. Thomas' Hospital, London SE1 7EH, UK.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Hajnal
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Taylor