Mangnus L, van Steenbergen H W, Reijnierse M, Kälvesten J, van der Helm-Van Mil Ahm
a Department of Rheumatology , Leiden University Medical Center , Leiden , the Netherlands.
b Department of Radiology , Leiden University Medical Center , Leiden , the Netherlands.
Scand J Rheumatol. 2017 Sep;46(5):364-368. doi: 10.1080/03009742.2017.1299217. Epub 2017 Jun 5.
Peripheral bone mineral density (BMD) may be decreased in early rheumatoid arthritis (RA) but it is unknown whether BMD loss emerges before arthritis is clinically apparent. We aimed to study whether BMD loss occurs in patients with clinically suspect arthralgia (CSA), and whether it is associated with progression to clinical arthritis and magnetic resonance imaging (MRI)-detected subclinical inflammation.
Patients with CSA had arthralgia for <1 year and were at risk of progressing to RA according to their rheumatologists. At baseline, a 1.5 T MRI was performed of unilateral metacarpophalangeal, wrist, and metatarsophalangeal joints, and scored on synovitis, bone marrow oedema, and tenosynovitis;. summing these features yielded the total MRI inflammation score. Digital X-ray radiogrammetry (DXR) was used to estimate BMD on two sequential conventional hand radiographs (mean interval between radiographs 4.4 months). The change in BMD was studied; BMD loss was defined as a decrease of ≥2.5 mg/cm/month. Patients were followed for arthritis development for a median of 18.4 months.
In CSA patients (n = 108), change in BMD was negatively associated with age (β = -0.03, p = 0.007). BMD loss in CSA patients was associated with arthritis development [adjusted for age hazard ratio (HR) = 6.1, 95% confidence interval (CI) 1.7 to 21.4] and was most frequently estimated in the months before clinical arthritis development. The total MRI inflammation scores were associated with the change in BMD (adjusted for age β = -0.05, p = 0.047). The total MRI inflammation score and BMD loss were both independently associated with arthritis development (HR = 1.1, 95% CI 1.1 to 1.2, and HR = 4.6, 95% CI 1.2 to 17.2, respectively).
In CSA patients, severe BMD loss is associated with MRI-detectable subclinical inflammation and with progression to clinical arthritis.
早期类风湿关节炎（RA）患者的外周骨密度（BMD）可能降低，但骨密度降低是否在关节炎临床表现出现之前就已出现尚不清楚。我们旨在研究临床疑似关节痛（CSA）患者是否存在骨密度降低，以及其是否与进展为临床关节炎和磁共振成像（MRI）检测到的亚临床炎症相关。
CSA患者关节痛时间<1年，根据其风湿病专家的判断有进展为RA的风险。在基线时，对单侧掌指关节、腕关节和跖趾关节进行1.5T MRI检查，并对滑膜炎、骨髓水肿和腱鞘炎进行评分；将这些特征相加得出MRI总炎症评分。使用数字X线摄影测量法（DXR）在两张连续的传统手部X线片上估计骨密度（两张X线片之间的平均间隔为4.4个月）。研究骨密度的变化；骨密度降低定义为每月降低≥2.5mg/cm。对患者进行关节炎发展情况随访，中位随访时间为18.4个月。
在CSA患者（n = 108）中，骨密度变化与年龄呈负相关（β = -0.03，p = 0.007）。CSA患者的骨密度降低与关节炎发展相关[校正年龄后的风险比（HR）= 6.1，95%置信区间（CI）为1.7至21.4]，且最常在临床关节炎发展前的几个月出现。MRI总炎症评分与骨密度变化相关（校正年龄后β = -0.05，p = 0.047）。MRI总炎症评分和骨密度降低均与关节炎发展独立相关（HR分别为1.1，95%CI为1.1至1.2，以及HR为4.6，95%CI为1.2至17.2）。
在CSA患者中，严重的骨密度降低与MRI可检测到的亚临床炎症以及进展为临床关节炎相关。
