Relationship between wrist bone mineral density and synovitis, erosion by ultra-sonography in female rheumatoid arthritis patients / 北京大学学报(医学版)

ABSTRACT

Objective:To find the correlation of wrist bone mineral density ( BMD ) to wrist synovitis and erosion , by comparing wrist BMD and ultrasonography .Methods: A number of 80 female RA pa-tients were examined by BMD measurement of the femoral neck , spine and non-dominant wrist using du-al-energy X-ray absorptiometry ( DXA ) .Synovitis of the wrist was examined by ultrasonography .The wrist joint ( radiocarpal joint , dorsal midline , and carpoulnar joint ) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation , tenosynovi-tis,tendinitis and bone erosion .Colour and power doppler ultrasonography ( PDUS) were used to sum the synovitis score .Results:We found( 1 ) In the study , 80 female RA patients were enrolled , the mean age was 54.6 ±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0 ±4.0 (14.8-31.2) kg/m2 .The Wrist BMD ( g/cm2 ) in RA significantly reduced, compared with normal controls (0.297 ±0.121 vs.0.420 ±0.180,P<0.01).(2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326 ±0.103 vs.0.285 ± 0 .132 ,P<0 .01 );the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA(47.8%vs.64.9%, P<0.05); the positive rate of bone erosion in wrist by ultra-sound was lower in early RA compared with the established RA (39.1%vs.56.1%, P<0.01).(3) The wrist BMD ( g/cm2 ) in RA with high disease activity reduced compared with moderate and low disease activity (0.267 ±0.140 vs.0.280 ±0.126) and (0.267 ±0.140 vs.0.320 ±0.103) respec-tively , P<0 .05 ) .The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group (85% vs.81.8% and 92.6% vs.81.8%, respectively).DAS28ESR was correlated with wrist BMD (r=-0.288, P<0.01).(4) A significant positive correlation was found between wrist and spine /femur BMD ( r=0.634, P<0.01, r=0.795, P<0.01), and a negative correlation between wrist and disease duration and DAS 28ESR (r=-0.286, r=-0.301,P<0.01).There was a highly significant positive correlation between wrist BMD and femur BMD (r=0.95,P<0.05).(5) RA patients in wrist osteoporosis group had higher RF positive rate and ACPA rate than wrist osteopenia group (75.5%vs.55.6%,P<0.05,100% vs.83.3%, P<0.05). The patients of BMD osteoporosis group had higher DAS 28ESR compared with osteopenia group (5.3 ± 1.8 vs.3.7 ±1.5, P<0.01).The percentages of synovitis (61.5%vs.51.7%, P<0.05), tendeni-tis (14.3%vs.10.0%, P<0.05) and bone erosion (54.2%vs.46.2%, P<0.05) in wrist by ultra-sonography in osteoporosis group were higher than those of osteopenia group .(6) The wrist BMD in ne-gative bone erosion group by ultrasonography was lower than that in positive bone erosion group [ (0.333 ± 0.107) g/cm2 vs.(0.264 ±0.125) g/cm2, P<0.01], also the PDUS score was higher than positive bone erosion group (4.53 ±1.40 vs.2.55 ±2.66,P<0.01).Compared with negative bone erosion group, the patients in positive bone erosion group had longer disease duration (96.0 ±104.7) months vs.(66.2 ±78.0) months, P<0.05), higher percentage of RF (81.0% vs.53.8%,P<0.01), ACPA (92.7%vs.79.5%, P<0.05).and higher DAS28ESR (5.4 ±1.8 vs.4.2 ±2.0,P<0.05). The percentage of wrist synovitis in positive bone erosion group was higher (75.6% vs.30.8%,P<0.01) than that of negative bone erosion group , and moreover , the percentage of severe osteoporosis in the wrist was significantly higher (75.0%vs.46.4%, P<0.01).(7) A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low wrist BMD.Statistically significant variables were age (P=0.001), disease duration (P=0.017), DAS28ESR (P=0.021), and ACPA (P=0.05).Conclusion:This study shows a highly sig-nificant correlation between hand BMD with disease duration and disease activity , and female RA patients with high titer of ACPA have lower wrist BMD .ABSTRACT Objective:To find the correlation of wrist bone mineral density ( BMD ) to wrist synovitis and erosion , by comparing wrist BMD and ultrasonography .Methods: A number of 80 female RA pa-tients were examined by BMD measurement of the femoral neck , spine and non-dominant wrist using du-al-energy X-ray absorptiometry ( DXA ) .Synovitis of the wrist was examined by ultrasonography .The wrist joint ( radiocarpal joint , dorsal midline , and carpoulnar joint ) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation , tenosynovi-tis,tendinitis and bone erosion .Colour and power doppler ultrasonography ( PDUS) were used to sum the synovitis score .Results:We found( 1 ) In the study , 80 female RA patients were enrolled , the mean age was 54.6 ±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0 ±4.0 (14.8-31.2) kg/m2 .The Wrist BMD ( g/cm2 ) in RA significantly reduced, compared with normal controls (0.297 ±0.121 vs.0.420 ±0.180,P<0.01).(2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326 ±0.103 vs.0.285 ± 0 .132 ,P<0 .01 );the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA(47.8%vs.64.9%, P<0.05); the positive rate of bone erosion in wrist by ultra-sound was lower in early RA compared with the established RA (39.1%vs.56.1%, P<0.01).(3) The wrist BMD ( g/cm2 ) in RA with high disease activity reduced compared with moderate and low disease activity (0.267 ±0.140 vs.0.280 ±0.126) and (0.267 ±0.140 vs.0.320 ±0.103) respec-tively , P<0 .05 ) .The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group (85% vs.81.8% and 92.6% vs.81.8%, respectively).DAS28ESR was correlated with wrist BMD (r=-0.288, P<0.01).(4) A significant positive correlation was found between wrist and spine /femur BMD ( r=0.634, P<0.01, r=0.795, P<0.01), and a negative correlation between wrist and disease duration and DAS 28ESR (r=-0.286, r=-0.301,P<0.01).There was a highly significant positive correlation between wrist BMD and femur BMD (r=0.95,P<0.05).(5) RA patients in wrist osteoporosis group had higher RF positive rate and ACPA rate than wrist osteopenia group (75.5%vs.55.6%,P<0.05,100% vs.83.3%, P<0.05). The patients of BMD osteoporosis group had higher DAS 28ESR compared with osteopenia group (5.3 ± 1.8 vs.3.7 ±1.5, P<0.01).The percentages of synovitis (61.5%vs.51.7%, P<0.05), tendeni-tis (14.3%vs.10.0%, P<0.05) and bone erosion (54.2%vs.46.2%, P<0.05) in wrist by ultra-sonography in osteoporosis group were higher than those of osteopenia group .(6) The wrist BMD in ne-gative bone erosion group by ultrasonography was lower than that in positive bone erosion group [ (0.333 ± 0.107) g/cm2 vs.(0.264 ±0.125) g/cm2, P<0.01], also the PDUS score was higher than positive bone erosion group (4.53 ±1.40 vs.2.55 ±2.66,P<0.01).Compared with negative bone erosion group, the patients in positive bone erosion group had longer disease duration (96.0 ±104.7) months vs.(66.2 ±78.0) months, P<0.05), higher percentage of RF (81.0% vs.53.8%,P<0.01), ACPA (92.7%vs.79.5%, P<0.05).and higher DAS28ESR (5.4 ±1.8 vs.4.2 ±2.0,P<0.05). The percentage of wrist synovitis in positive bone erosion group was higher (75.6% vs.30.8%,P<0.01) than that of negative bone erosion group , and moreover , the percentage of severe osteoporosis in the wrist was significantly higher (75.0%vs.46.4%, P<0.01).(7) A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low wrist BMD.Statistically significant variables were age (P=0.001), disease duration (P=0.017), DAS28ESR (P=0.021), and ACPA (P=0.05).Conclusion:This study shows a highly sig-nificant correlation between hand BMD with disease duration and disease activity , and female RA patients with high titer of ACPA have lower wrist BMD .