Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
Osteoporos Int. 2012 Nov;23(11):2671-9. doi: 10.1007/s00198-012-1897-x. Epub 2012 Feb 18.
The bone mineral density (BMD) measurement of the hand in rheumatoid arthritis (RA) patients is no standard measurement method as yet. The aim was to contribute to the standardization of the hand BMD measurement, especially of periarticular regions. As results, we found best precision values for the wrist and a significant correlation between hand and spine/femur BMD depending on disease activity and disease duration.
This study was conducted to investigate (i) the precision of periarticular hand BMD measuring, (ii) the periarticular demineralization of the hand, (iii) the correlation between periarticular hand BMD and spine/femur BMD, and (iv) the correlation of hand BMD to hand synovitis.
A number of 52 RA patients were examined by BMD measurement of the femoral neck, spine, whole hand, metacarpophalangeal (MCP) joints II-V, personal identity profile (PIP) joints II-V, and wrist using dual-energy X-ray absorptiometry (DXA). Synovitis of the hand was examined by ultrasonography and magnetic resonance imaging (MRI). Three subgroups were further analyzed: early RA, established RA with moderate and with high disease activity. Early RA and established RA patients with high disease activity were Followed up after 12 months.
We found (1) best precision of BMD measurement for the wrist, (2) BMD in RA significantly reduced if compared to normal controls, (3) a highly significant positive correlation between hand and spine/femur BMD and the power of correlation to depend on disease activity and disease duration (high correlation in RA with moderate disease activity and early RA, very high correlation in RA with high disease activity), (4) a negative correlation between hand BMD and hand synovitis in RA with high disease activity, and (5) a significant reduction of synovitis but no change in hand BMD after 12 months, respectively.
This study shows a highly significant correlation between hand BMD and spine/femur BMD in RA patients depending on disease activity and disease duration. We conclude to measure BMD at different sites including hands in order to quantify bone loss in RA patients most properly.
目的是对手的 BMD 测量进行标准化，特别是对手部关节周围区域的测量。研究发现，腕部的精度值最佳，且手部和脊柱/股骨 BMD 之间存在显著相关性，这种相关性取决于疾病活动度和疾病持续时间。
共对 52 例 RA 患者进行了股骨颈、脊柱、全手、掌指关节（MCP）II-V、指间关节（PIP）II-V、腕部的双能 X 线吸收法（DXA）BMD 测量，同时用超声和磁共振成像（MRI）检测手部滑膜炎。进一步对三组患者进行分析：早期 RA、活动度中-高度的定型 RA。活动度中-高度的早期 RA 和定型 RA 患者在 12 个月后进行了随访。
我们发现（1）腕部的 BMD 测量精度最佳，（2）与正常对照组相比，RA 患者的 BMD 显著降低，（3）手部和脊柱/股骨 BMD 之间存在高度显著的正相关，相关程度取决于疾病活动度和疾病持续时间（活动度中度的 RA 和早期 RA 相关性高，活动度高度的 RA 相关性极高），（4）活动度高度的 RA 患者手部 BMD 与滑膜炎呈负相关，（5）分别在 12 个月时，滑膜炎显著减少，但手部 BMD 无变化。
本研究表明，RA 患者的手部 BMD 与脊柱/股骨 BMD 之间存在高度显著的相关性，这种相关性取决于疾病活动度和疾病持续时间。我们得出的结论是，为了更准确地评估 RA 患者的骨质流失，需要在手部等不同部位进行 BMD 测量。
