Accelerated hand bone mineral density loss is associated with progressive joint damage in hands and feet in recent-onset rheumatoid arthritis

Abstract

Introduction: To investigate whether accelerated hand bone mineral density (BMD) loss is associated with progressive joint damage in hands and feet in the first year of rheumatoid arthritis (RA) and whether it is an independent predictor of subsequent progressive total joint damage after 4 years.

Methods: In 256 recent-onset RA patients, baseline and 1-year hand BMD was measured in metacarpals 2-4 by digital X-ray radiogrammetry. Joint damage in hands and feet were scored in random order according to the Sharp-van der Heijde method at baseline and yearly up to 4 years.

Results: 68% of the patients had accelerated hand BMD loss (>-0.003 g/cm2) in the first year of RA. Hand BMD loss was associated with progressive joint damage after 1 year both in hands and feet with odds ratios (OR) (95% confidence intervals [CI]) of 5.3 (1.3-20.9) and 3.1 (1.0-9.7). In univariate analysis, hand BMD loss in the first year was a predictor of subsequent progressive total joint damage after 4 years with an OR (95% CI) of 3.1 (1.3-7.6). Multivariate analysis showed that only progressive joint damage in the first year and anti-citrullinated protein antibody positivity were independent predictors of long-term progressive joint damage.

Conclusions: In the first year of RA, accelerated hand BMD loss is associated with progressive joint damage in both hands and feet. Hand BMD loss in the first year of recent-onset RA predicts subsequent progressive total joint damage, however not independent of progressive joint damage in the first year.

Figure 1

Cumulative probability plot of changes in Sharp-van der Heijde score (SHS). Results are shown in both hands and feet, in only hands and in only feet after one year in recent-onset active rheumatoid arthritis patients with accelerated hand bone mineral density (BMD) loss (triangles) and without accelerated hand BMD loss (circles) after one year.

Figure 2

Mean progression of total Sharp-van der Heijde (SHS) in hands and feet after up to four years in patients with (black columns) and without (white columns) hand bone mineral density (BMD) loss in the first year of rheumatoid arthritis. The differences in mean total SHS progression after one, two, three and four years between patients with and without hand BMD loss in the first year are all significant (P < 0.05 derived by non-parametric tests).