Open Access Research article

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

Melek Güler-Yüksel1*, Naomi B Klarenbeek1, Yvonne PM Goekoop-Ruiterman1, Jeska K de Vries-Bouwstra2, Sjoerd M van der Kooij1, Andreas H Gerards3, H Karel Ronday4, Tom WJ Huizinga1, Ben AC Dijkmans2,5, Cornelia F Allaart1 and Willem F Lems2,5

Author Affiliations

1 Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

2 Department of Rheumatology, VU Medical Center, De Boelelaan 1109, 1007 MB Amsterdam, The Netherlands

3 Department of Rheumatology, Vlietland Hospital, Burgemeester Knappertlaan 25, 3116 BA Schiedam, The Netherlands

4 Haga Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands

5 Department of Rheumatology, Jan van Breemen Institute, Dr Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands

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Arthritis Research & Therapy 2010, 12:R96 doi:10.1186/ar3025

Published: 20 May 2010

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.