Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.
Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands.
Calcif Tissue Int. 2019 Jun;104(6):571-581. doi: 10.1007/s00223-019-00523-2. Epub 2019 Feb 1.
The purpose of the study was to prospectively investigate change (repair or progression) in the number, surface area and volume of cortical interruptions, bone density (vBMD) and micro-structural parameters assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) in finger joints of patients with rheumatoid arthritis (RA) treated with synthetic disease modifying anti-rheumatic drugs (sDMARDs) and/or biologic DMARDs (bDMARDs) over a 1-year follow-up period, and in comparison with healthy subjects (HS).
Thirty-two patients with RA (221 joints, 53% on bDMARDs) and 32 HS (117 joints) were assessed at baseline and after 1 year using semi-automatic analysis of HR-pQCT images. Mean changes (group level) and the proportion of joints (joint level) with changes beyond the least significant change were calculated.
At baseline, 530 interruptions were identified in patients, and 136 in HS. The mean of the interruption parameters did not significantly change in either group Mean vBMD decreased more in patients than in HS (- 4.4 versus - 1.1 mgHA/cm, respectively). In patients versus HS, proportionally more joints showed repair in interruption volume (6.6% versus 1.7%, respectively) and loss of vBMD (26.7% versus 12.9%, respectively). In patients on sDMARDs versus patients on bDMARDs, proportionally more joints showed progression in the number of interruptions and loss of vBMD (6.1% versus 1.8% and 31.3% versus 17.2%, respectively).
HR-pQCT is able to quantify bone repair and progression. Cortical interruption-, vBMD-, and micro-structure were impaired in RA, of which vBMD and micro-structure further deteriorated, particularly in patients on sDMARDs.
本研究旨在前瞻性地观察接受合成改善病情抗风湿药物（sDMARDs）和/或生物改善病情抗风湿药物（bDMARDs）治疗的类风湿关节炎（RA）患者手指关节皮质中断数量、面积和体积、骨密度（vBMD）以及通过高分辨率外周定量 CT（HR-pQCT）评估的微结构参数的变化（修复或进展），并与健康受试者（HS）进行比较。
32 例 RA 患者（221 个关节，53%接受 bDMARDs 治疗）和 32 例 HS 在基线和 1 年后使用 HR-pQCT 图像半自动分析进行评估。计算了（组水平）平均变化和（关节水平）变化超过最小有意义变化的关节比例。
基线时，患者中有 530 个中断，HS 中有 136 个中断。两组中断参数的平均值均无明显变化。患者的 vBMD 平均值下降（-4.4 比-1.1mgHA/cm）比 HS 更明显。与 HS 相比，患者中更多的关节在中断体积（分别为 6.6%和 1.7%）和 vBMD 丧失（分别为 26.7%和 12.9%）方面显示出修复。与 bDMARD 治疗的患者相比，接受 sDMARD 治疗的患者在中断数量和 vBMD 丧失方面有更多的关节显示出进展（分别为 6.1%和 1.8%以及 31.3%和 17.2%）。
HR-pQCT 能够定量评估骨修复和进展。RA 患者的皮质中断、vBMD 和微结构受损，其中 vBMD 和微结构进一步恶化，特别是接受 sDMARD 治疗的患者。
