Hand bone loss as noted on a dual-energy absorptiometry scan may make earlier diagnosis of rheumatoid arthritis possible in patients with joint pain, reported Dr. Paul Emery and his colleagues at the University of Leeds, (England).
Dual-energy absorptiometry (DXA) scans in 74 patients with undifferentiated arthritis lasting less than 12 months showed significant changes in hand bone mineral density (BMD) in patients who were eventually diagnosed with rheumatoid arthritis (RA), Dr. Emery and his colleagues reported.
“This longitudinal study supports the view that hand BMD loss, even at the earliest stages of the disease process, is related to measures of disease activity and severity in rheumatoid arthritis,” the investigators wrote (Ann. Rheum. Dis. 2006;65:736–40).
The study participants were mostly women (88%), with an average age of 44 years. They underwent serial BMD measurements of the hands, femoral neck, and spine (L2–L4) using serial DXA scans at baseline, and at 3, 6, and 12 months, the investigators reported.
None of the patients had received disease-modifying drugs or prednisone prior to the start of the study.
Patients had ongoing diagnostic tests for RA during the study period. Thirteen patients were eventually diagnosed as having RA, 19 patients were determined to have inflammatory nonrheumatoid joint disorders, and the remaining 42 patients were diagnosed with noninflammatory joint disorders, Dr. Emery and his fellow investigators reported.
The results revealed that at 12-month follow-up, none of the patient groups sustained significant bone loss at the femoral neck and spine.
However, patients who were eventually diagnosed with RA had significant hand BMD loss at 12 months, compared with the other patient groups.
In patients diagnosed with RA, hand BMD loss was 4.27%; the inflammatory non-RA group had a 0.49% loss; and the noninflammatory joint disorder group had a BMD loss of 0.87%, the investigators reported.