Periarticular osteoporosis is a prominent feature in early rheumatoid arthritis: estimation using shaft to periarticular bone mineral density ratio

Abstract

We aimed to quantify periarticular osteoporosis and investigate its significance in 45 patients with rheumatoid arthritis (RA) and 106 controls. Dual-energy X-ray absorptiometry (DXA) was used to determine the ratio of shaft to periarticular bone mineral density (BMD) as an index of periarticular demineralization. Periarticular osteoporosis was measured by conventional radiography. The BMDs of shaft and periarticular regions in eight designated areas on proximal phalanges were quantified. Clinical variables were examined to identify risk factors for periarticular osteoporosis. The assessment of periarticular osteoporosis on X-ray images reached a moderate degree of interobserver agreement among four physicians (ĸ = 0.47). For BMD quantification, we designed three types of mathematical formulae: the ratio of shaft to periarticular BMD, the mean of the ratios, and the ratio of the sums. These ratios were significantly higher in the patients with early RA (disease duration ≤ 3 yr) than in controls (P < 0.01). The findings were not as distinctive in patients with established RA. Body mass index, cumulative dose of corticosteroid, and C-terminal telopeptide were correlated with BMD ratios. Conclusively, DXA-assisted localized quantification and BMD ratio calculations are feasible for assessing periarticular demineralization. Periarticular osteoporosis is a relatively distinctive feature of early RA.

Keywords: Arthrits; Bone Density; Periarticular Osteopenia; Rheumatoid.

Fig. 1

Evaluation of localized articular and periarticular ROIs with DXA. We labeled left and right hands with L and R, respectively, which were followed by numbers (x) from 1 to 4 for periarticular BMDs and 1' to 4' for middle-of-the-bone BMDs.

Fig. 2

Calculated values according to the existence of periarticular osteoporosis. The values representing periarticular osteoporosis (n = 66 [presence of periarticular osteoporosis] and n = 85 [absence of periarticular osteoporosis]) are expressed as dot plots with mean (bar).

Fig. 3

Correlation between the duration of RA and the mean of both mid-to-peri BMD ratios. R² = 0.158, Pearson correlation coefficient = -0.398.