title: Is there a role for Digital X-ray Radiogrammetry as surrogate marker for radiological progression and imaging of structural integrity in rheumatoid arthritis?
abstract: BACKGROUND
  The established scoring techniques based on radiographs present limitations in the evaluation of structural integrity due to high effectiveness of innovative therapeutic strategies. The aim of this study was to evaluate the periarticular mineralisation as detected by Digital X-ray Radiogrammetry (DXR) as surrogate marker for structural integrity during the course of rheumatoid arthritis (RA).
  
  
  METHODS
  11 centers throughout Germany contributed data of 94 patients with verified RA. The patients were treated with leflunomide or methotrexate during a mean observation period of 22 months. All patients underwent complete computerized calculations of bone mineral density (BMD) and metacarpal index (MCI) by DXR using digitized hand radiographs. The radiological assessment of disease progression was estimated by the Sharp Score.
  
  
  RESULTS
  The Sharp Score revealed no significant change during the study period. DXR-BMD revealed minimal decrease of -1.4 % (leflunomide group) versus a higher reduction of -4.3 % (methotrexate group). Regarding DXR-MCI, a reduction of -2.2 % (leflunomide group) and -4.9 % (methotrexate group) was observed.
  
  
  CONCLUSIONS
  Quantitative data of hand bone mass estimated by the presented DXR-technique may be a complementary precise tool in the identification of RA-related radiographic changes and in the assessment of structural integrity.
authors.affiliation: Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. alexander.pfeil@med.uni-jena.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Pfeil
authors.affiliation: Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. peter.oelzner@med.uni-jena.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Oelzner
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. diane.renz@med.uni-jena.de.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Renz
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Heinrich - Braun - Clinic Zwickau, Karl-Kreil-Straße 35, 08060, Zwickau, Germany. andreas.hansch@HBK-Zwickau.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hansch
authors.affiliation: Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. gunter.wolf@med.uni-jena.de.
authors.forename: Gunter
authors.initials: G
authors.lastname: Wolf
authors.affiliation: Institute of Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera GmbH, Straße des Friedens 122, 07548, Gera, Germany. joachim.boettcher@wkg.srh.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Böttcher
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D001175:Arthrography / Q000379:methods*; D015519:Bone Density / Q000187:drug effects; D018450:Disease Progression; D005260:Female; D005858:Germany; D050823:Hand Joints / Q000000981:diagnostic imaging* / Q000187:drug effects; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D000077339:Leflunomide; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007555:Isoxazoles; D000077339:Leflunomide; D008727:Methotrexate