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. 2017 Jun 29;3(1):e000369.
doi: 10.1136/rmdopen-2016-000369. eCollection 2017.

Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

Michael Platten  1 , Yogan Kisten  1 , Johan Kälvesten  2   3 , Laurent Arnaud  1 , Kristina Forslind  4   5 , Ronald van Vollenhoven  1   6
Affiliations

Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

Michael Platten et al. RMD Open. .

Abstract

Objectives: To study fully automated digital joint space width (JSW) and bone mineral density (BMD) in relation to a conventional radiographic scoring method in early rheumatoid arthritis (eRA).

Methods: Radiographs scored by the modified Sharp van der Heijde score (SHS) in patients with eRA were acquired from the SWEdish FarmacOTherapy study. Fully automated JSW measurements of bilateral metacarpals 2, 3 and 4 were compared with the joint space narrowing (JSN) score in SHS. Multilevel mixed model statistics were applied to calculate the significance of the association between ΔJSW and ΔBMD over 1 year, and the JSW differences between damaged and undamaged joints as evaluated by the JSN.

Results: Based on 576 joints of 96 patients with eRA, a significant reduction from baseline to 1 year was observed in the JSW from 1.69 (±0.19) mm to 1.66 (±0.19) mm (p<0.01), and BMD from 0.583 (±0.068) g/cm2 to 0.566 (±0.074) g/cm2 (p<0.01). A significant positive association was observed between ΔJSW and ΔBMD over 1 year (p<0.0001). On an individual joint level, JSWs of undamaged (JSN=0) joints were wider than damaged (JSN>0) joints: 1.68 mm (95% CI 1.70 to 1.67) vs 1.54 mm (95% CI 1.63 to 1.46). Similarly the unadjusted multilevel model showed significant differences in JSW between undamaged (1.68 mm (95% CI 1.72 to 1.64)) and damaged joints (1.63 mm (95% CI 1.68 to 1.58)) (p=0.0048). This difference remained significant in the adjusted model: 1.66 mm (95% CI 1.70 to 1.61) vs 1.62 mm (95% CI 1.68 to 1.56) (p=0.042).

Conclusions: To measure the JSW with this fully automated digital tool may be useful as a quick and observer-independent application for evaluating cartilage damage in eRA.

Trial registration number: NCT00764725.

Keywords: Automated; Bone Mineral Density; Joint Space Width; Radiographic scoring; Rheumatoid Arthritis.

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Conflict of interest statement

Competing interests: JK is employed by Sectra AB. No other conflicts of interests to declare.

Figures

Figure 1
Figure 1
Flow chart of patient selection.
Figure 2
Figure 2
Radiograph of hand with highlighted measurement regions. Posteroanterior radiograph of the left hand with measurement boxes placed at MCP 2, 3 and 4 in order to measure joint space width. Measurement boxes are also placed on the metacarpal bones 2, 3 and 4 in order to measure bone mineral density. MCP, metacarpophalangeal.
Figure 3
Figure 3
JSW, BMD and SHS at baseline and 12 months. Whiskers demonstrate SD of the mean. (A) Demonstrates the JSW of MCP 2, 3 and 4 at baseline and at 1 year. (B) Demonstrates the BMD of the left and right hand at baseline and at 1 year. (C) Demonstrates erosion score, JSN score and the SHS at baseline and at 1 year. *Significant difference, p<0.05; **significant difference, p<0.01. BMD, bone mineral density; JSN, joint space narrowing; JSW, joint space width; MCP, metacarpophalangeal; SHS, Sharp van der Heijde score.
Figure 4
Figure 4
Distribution of joints with damage or no damage: raw data, unadjusted and adjusted model. On an individual joint level, the JSW when a joint received a JSN score of 0 and when a joint received a JSN score of >0 for the raw data, as well as for the unadjusted and adjusted multilevel models, is illustrated. Whiskers represent 95% CI. *Significant difference, p<0.05; **significant difference, p<0.01. JSN, joint space narrowing; JSW, joint space width.
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