title: Heterogeneity of Cortical Breaks in Hand Joints of Patients with Rheumatoid Arthritis and Healthy Controls Imaged by High-resolution Peripheral Quantitative Computed Tomography.
abstract: Conventional radiographs (CR) of the hands are the gold standard for imaging bone erosions. The presence of bone erosions, reflected by the presence of cortical breaks, is a poor prognostic factor in patients with rheumatoid arthritis (RA). The availability of high-resolution peripheral quantitative computed tomography (HR-pQCT) enables detailed investigation of cortical breaks in rheumatic diseases. The aim of this image review is to show HR-pQCT images of the spectrum of cortical breaks with and without underlying trabecular bone changes in metacarpophalangeal (MCP) joints of healthy controls (HC) and patients with RA, with corresponding images on CR and magnetic resonance imaging (MRI).
  
  
  
  Second and third MCP joints of 41 patients (of which 10 were early RA with ≤ 2 years and 24 longstanding RA with ≥ 10 years of disease duration) and 38 HC were imaged by CR, MRI, and HR-pQCT (XtremeCT1, Scanco Medical AG). Representative images of the spectrum of cortical breaks were selected.
  
  
  
  Cortical breaks were found in early and longstanding RA, but also in HC. They were heterogeneous in size, location, and number per joint, with a variety of surrounding cortical and underlying trabecular bone characteristics.
  
  
  
  Using HR-pQCT images of MCP joints, heterogeneous cortical breaks with and without surrounding trabecular bone changes were found, not only in RA but also in HC. The underlying mechanisms and significance of this spectrum of cortical breaks as found with high 3-D resolution needs further investigation.
authors.affiliation: From the Department of Medicine, Division of Rheumatology, Maastricht University Medical Center (MUMC); CAPHRI, School for Public Health and Primary Care; NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; Department of Internal Medicine, Viecuri Medical Center, Venlo, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.A. Scharmga, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; M. Peters, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, MUMC, and CAPHRI; J. van den Bergh, MD, PhD, Department of Internal Medicine, Viecuri Medical Center, NUTRIM, and Faculty of Medicine and Life Sciences, Hasselt University; C. Barnabe, MD, PhD, FRCPC, Medicine and Community Health Sciences, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg; B. van Rietbergen, PhD, Faculty of Biomedical Engineering, Eindhoven University of Technology; P. Geusens, MD, PhD, Faculty of Medicine and Life Sciences, Hasselt University, and CAPHRI. a.scharmga@maastrichtuniversity.nl.
authors.forename: Andrea
authors.initials: A
authors.lastname: Scharmga
authors.affiliation: From the Department of Medicine, Division of Rheumatology, Maastricht University Medical Center (MUMC); CAPHRI, School for Public Health and Primary Care; NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; Department of Internal Medicine, Viecuri Medical Center, Venlo, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.A. Scharmga, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; M. Peters, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, MUMC, and CAPHRI; J. van den Bergh, MD, PhD, Department of Internal Medicine, Viecuri Medical Center, NUTRIM, and Faculty of Medicine and Life Sciences, Hasselt University; C. Barnabe, MD, PhD, FRCPC, Medicine and Community Health Sciences, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg; B. van Rietbergen, PhD, Faculty of Biomedical Engineering, Eindhoven University of Technology; P. Geusens, MD, PhD, Faculty of Medicine and Life Sciences, Hasselt University, and CAPHRI.
authors.forename: Michiel
authors.initials: M
authors.lastname: Peters
authors.affiliation: From the Department of Medicine, Division of Rheumatology, Maastricht University Medical Center (MUMC); CAPHRI, School for Public Health and Primary Care; NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; Department of Internal Medicine, Viecuri Medical Center, Venlo, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.A. Scharmga, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; M. Peters, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, MUMC, and CAPHRI; J. van den Bergh, MD, PhD, Department of Internal Medicine, Viecuri Medical Center, NUTRIM, and Faculty of Medicine and Life Sciences, Hasselt University; C. Barnabe, MD, PhD, FRCPC, Medicine and Community Health Sciences, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg; B. van Rietbergen, PhD, Faculty of Biomedical Engineering, Eindhoven University of Technology; P. Geusens, MD, PhD, Faculty of Medicine and Life Sciences, Hasselt University, and CAPHRI.
authors.forename: Astrid
authors.initials: A
authors.lastname: van Tubergen
authors.affiliation: From the Department of Medicine, Division of Rheumatology, Maastricht University Medical Center (MUMC); CAPHRI, School for Public Health and Primary Care; NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; Department of Internal Medicine, Viecuri Medical Center, Venlo, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.A. Scharmga, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; M. Peters, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, MUMC, and CAPHRI; J. van den Bergh, MD, PhD, Department of Internal Medicine, Viecuri Medical Center, NUTRIM, and Faculty of Medicine and Life Sciences, Hasselt University; C. Barnabe, MD, PhD, FRCPC, Medicine and Community Health Sciences, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg; B. van Rietbergen, PhD, Faculty of Biomedical Engineering, Eindhoven University of Technology; P. Geusens, MD, PhD, Faculty of Medicine and Life Sciences, Hasselt University, and CAPHRI.
authors.forename: Joop
authors.initials: J
authors.lastname: van den Bergh
authors.affiliation: From the Department of Medicine, Division of Rheumatology, Maastricht University Medical Center (MUMC); CAPHRI, School for Public Health and Primary Care; NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; Department of Internal Medicine, Viecuri Medical Center, Venlo, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.A. Scharmga, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; M. Peters, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, MUMC, and CAPHRI; J. van den Bergh, MD, PhD, Department of Internal Medicine, Viecuri Medical Center, NUTRIM, and Faculty of Medicine and Life Sciences, Hasselt University; C. Barnabe, MD, PhD, FRCPC, Medicine and Community Health Sciences, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg; B. van Rietbergen, PhD, Faculty of Biomedical Engineering, Eindhoven University of Technology; P. Geusens, MD, PhD, Faculty of Medicine and Life Sciences, Hasselt University, and CAPHRI.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
authors.affiliation: From the Department of Medicine, Division of Rheumatology, Maastricht University Medical Center (MUMC); CAPHRI, School for Public Health and Primary Care; NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; Department of Internal Medicine, Viecuri Medical Center, Venlo, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.A. Scharmga, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; M. Peters, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, MUMC, and CAPHRI; J. van den Bergh, MD, PhD, Department of Internal Medicine, Viecuri Medical Center, NUTRIM, and Faculty of Medicine and Life Sciences, Hasselt University; C. Barnabe, MD, PhD, FRCPC, Medicine and Community Health Sciences, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg; B. van Rietbergen, PhD, Faculty of Biomedical Engineering, Eindhoven University of Technology; P. Geusens, MD, PhD, Faculty of Medicine and Life Sciences, Hasselt University, and CAPHRI.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Finzel
authors.affiliation: From the Department of Medicine, Division of Rheumatology, Maastricht University Medical Center (MUMC); CAPHRI, School for Public Health and Primary Care; NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; Department of Internal Medicine, Viecuri Medical Center, Venlo, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.A. Scharmga, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; M. Peters, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, MUMC, and CAPHRI; J. van den Bergh, MD, PhD, Department of Internal Medicine, Viecuri Medical Center, NUTRIM, and Faculty of Medicine and Life Sciences, Hasselt University; C. Barnabe, MD, PhD, FRCPC, Medicine and Community Health Sciences, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg; B. van Rietbergen, PhD, Faculty of Biomedical Engineering, Eindhoven University of Technology; P. Geusens, MD, PhD, Faculty of Medicine and Life Sciences, Hasselt University, and CAPHRI.
authors.forename: Bert
authors.initials: B
authors.lastname: van Rietbergen
authors.affiliation: From the Department of Medicine, Division of Rheumatology, Maastricht University Medical Center (MUMC); CAPHRI, School for Public Health and Primary Care; NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; Department of Internal Medicine, Viecuri Medical Center, Venlo, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.A. Scharmga, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; M. Peters, MSc, Department of Medicine, Division of Rheumatology, MUMC, CAPHRI, and NUTRIM; A. van Tubergen, MD, PhD, Department of Medicine, Division of Rheumatology, MUMC, and CAPHRI; J. van den Bergh, MD, PhD, Department of Internal Medicine, Viecuri Medical Center, NUTRIM, and Faculty of Medicine and Life Sciences, Hasselt University; C. Barnabe, MD, PhD, FRCPC, Medicine and Community Health Sciences, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg; B. van Rietbergen, PhD, Faculty of Biomedical Engineering, Eindhoven University of Technology; P. Geusens, MD, PhD, Faculty of Medicine and Life Sciences, Hasselt University, and CAPHRI.
authors.forename: Piet
authors.initials: P
authors.lastname: Geusens
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D000071556:Cancellous Bone / Q000000981:diagnostic imaging; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D050823:Hand Joints / Q000000981:diagnostic imaging* / Q000293:injuries*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: BONE; COMPUTED TOMOGRAPHY; RHEUMATOID ARTHRITIS