Hoff M, Haugeberg G, Odegård S, Syversen S, Landewé R, van der Heijde D, Kvien T K
Department of Rheumatology, St. Olav's Hospital, University Hospital in Trondheim, Trondheim, Norway.
Ann Rheum Dis. 2009 Mar;68(3):324-9. doi: 10.1136/ard.2007.085985. Epub 2008 Mar 13.
To examine 1-year hand bone loss in early rheumatoid arthritis (RA) as a predictor of radiographic damage at 5-year and 10-year follow-up
A total of 136 patients with RA (disease duration 0-4 years) were followed for 10 years with clinical data and hand radiographs. Joint damage was scored according to the van der Heijde modification of the Sharp method (vdH Sharp score) and hand bone mineral density (BMD) was measured by digital x ray radiogrammetry (DXR). Group comparisons, correlation analyses and multivariate analyses were performed to evaluate the relationship between hand bone loss and radiographic joint damage.
Patients with hand BMD loss at 1 year had a higher median increase in vdH Sharp score compared to patients without loss at 5 years (12 vs 2, p = 0.001) and 10 years (22 vs 4, p = 0.002). In a linear regression model adjusting for age, gender, baseline C-reactive protein (CRP), anti-cyclic citrullinated peptide (CCP), IgM rheumatoid factor (RF) and radiographic damage, absolute hand DXR-BMD loss at 1 year was an independent predictor of radiographic outcome at 5 years (p<0.01) and 10 years (p = 0.02). In a logistic regression model the odds ratio (95% CI) for radiographic progression among patients with hand BMD loss was 3.5 (1.4 to 8.8) and 3.5 (1.4 to 8.4) at 5 and 10 years, respectively.
Early hand bone loss measured by DXR-BMD is an independent predictor of subsequent radiographic damage. Our findings support that quantitative hand bone loss in RA precedes radiographic joint damage and may be used as a tool for assessment of bone involvement in RA.
研究早期类风湿关节炎（RA）患者1年手部骨质流失情况，以此作为5年和10年随访时影像学损伤的预测指标。
对136例RA患者（病程0 - 4年）进行为期10年的随访，记录临床数据并拍摄手部X光片。根据Sharp方法的van der Heijde改良版（vdH Sharp评分）对关节损伤进行评分，采用数字X线骨密度测定法（DXR）测量手部骨矿物质密度（BMD）。进行组间比较、相关性分析和多变量分析，以评估手部骨质流失与影像学关节损伤之间的关系。
1年时手部BMD流失的患者，其vdH Sharp评分的中位数增加幅度在5年时高于无流失的患者（12比2，p = 0.001），在10年时也更高（22比4，p = 0.002）。在一个校正了年龄、性别、基线C反应蛋白（CRP）、抗环瓜氨酸肽（CCP）、IgM类风湿因子（RF）和影像学损伤的线性回归模型中，1年时手部DXR - BMD的绝对流失是5年（p<0.01）和10年（p = 0.02）时影像学结果的独立预测指标。在一个逻辑回归模型中，手部BMD流失患者在5年和10年时影像学进展的比值比（95%可信区间）分别为3.5（1.4至8.8）和3.5（1.4至8.4）。
通过DXR - BMD测量的早期手部骨质流失是后续影像学损伤的独立预测指标。我们的研究结果支持RA患者手部定量骨质流失先于影像学关节损伤，并且可作为评估RA骨受累情况的一种工具。
