Malaise O, Rinkin C, Gerard C, Chauveheid F, Seidel L, Malaise M, Ribbens C
Rheumatology department, University Hospital of Liège, Avenue de l'hôpital, 1, Liège, 4000, Belgium.
Biostatistics and research method center (B-STAT), University Hospital of Liège, Liège, Belgium.
Aging Clin Exp Res. 2025 Jun 28;37(1):199. doi: 10.1007/s40520-025-03105-5.
BACKGROUND/AIMS: We investigate if rheumatoid arthritis (RA) activity, defined clinically and with ultrasound, is associated with bone macro- and micro-architecture impairment on high-resolution peripheral quantitative computed tomography (HR-pQCT) and dual X-ray densitometry (DEXA).
Disease activity was evaluated in 61 RA patients, with clinical indices and ultrasound (hands and wrists). Bone mineral density (BMD) and architecture were analyzed with HR-pQCT and DEXA.
Ultrasound RA disease activity parameters [synovitis, power doppler (PD)-positive joints, sum of positive power doppler signals and tenosynovitis] were associated with altered HR-pQCT bone density and structure at tibia or radius (trabecular volumetric BMD, trabecular bone volume fraction, trabecular thickness and cortical porosity). In addition, wrist ultrasound activity was specifically locally associated with impaired local bone microarchitecture at distal ipsilateral radius. Clinical and functional RA disease activity parameters (number of swollen joints, Health Assessment Questionnaire and disease activity score DAS28-CRP) were also correlated with HR-pQCT parameters (total and trabecular volumetric BMD, trabecular thickness and cortical thickness). At the hip, BMD correlated with VAS-fatigue and DAS28-ESR. The number of synovitis detected by ultrasound was higher when total hip T-score was lower than - 1.
Ultrasound and clinical disease activity parameters were associated with impaired HR-pQCT parameters (distal radius and tibia), with lower trabecular and cortical bone densities and impaired bone microarchitecture (organization of spans and cortical porosity). In addition to systemic contribution to bone impairment, a local correlation between wrist US activity and HR-pQCT at distal radius was observed.
Patients with active RA, especially with US evaluation, are at higher risk for altered bone density and structure.
背景/目的：我们研究临床定义及超声定义的类风湿关节炎（RA）活动度是否与高分辨率外周定量计算机断层扫描（HR-pQCT）和双能X线骨密度仪（DEXA）检测的骨宏观及微观结构损害相关。
对61例RA患者进行疾病活动度评估，采用临床指标及超声检查（手部和腕部）。使用HR-pQCT和DEXA分析骨密度及结构。
超声RA疾病活动度参数[滑膜炎、能量多普勒（PD）阳性关节、能量多普勒信号阳性总和及腱鞘炎]与胫骨或桡骨HR-pQCT骨密度及结构改变相关（骨小梁体积骨密度、骨小梁体积分数、骨小梁厚度及皮质骨孔隙率）。此外，腕部超声活动度与同侧桡骨远端局部骨微观结构受损存在特异性局部关联。临床及功能RA疾病活动度参数（肿胀关节数、健康评估问卷及疾病活动度评分DAS28-CRP）也与HR-pQCT参数（总体积骨密度和骨小梁体积骨密度、骨小梁厚度及皮质骨厚度）相关。在髋部，骨密度与视觉模拟评分法-疲劳及DAS28-红细胞沉降率相关。当全髋T值低于-1时，超声检测到的滑膜炎数量更多。
超声及临床疾病活动度参数与HR-pQCT参数（桡骨远端和胫骨）受损相关，表现为骨小梁和皮质骨密度降低及骨微观结构受损（骨小梁间距和皮质骨孔隙率）。除了对骨损害的全身性影响外，还观察到腕部超声活动度与桡骨远端HR-pQCT之间存在局部相关性。
活动期RA患者，尤其是经超声评估的患者，骨密度和结构改变的风险更高。
