High-Resolution Peripheral Quantitative CT Helps Assess RA Bone Damage

deformed woman's hands from rheumatoid arthritis
deformed woman’s hands from rheumatoid arthritis
High-resolution peripheral quantitative computed tomography may be a valuable additional imaging modality to assess rheumatoid arthritis structural damage.

High-resolution peripheral quantitative computed tomography (HR-pQCT) may help evaluate structural damage in rheumatoid arthritis (RA) in addition to conventional radiography (CR) and magnetic resonance imaging (MRI), according to results published in the Journal of Bone and Mineral Research.

Patients with RA had more and larger cortical interruptions (detected via HR-pQCT) in their finger joints compared with healthy patients. These interruptions were associated with structural damage and inflammatory markers found with CR and MRI.

The study included participants with RA (n=39) and healthy controls (n=38) who were examined using CR, MRI, and HR-pQCT. The researchers scored CRs using the Sharp/Van der Heijde method. They analyzed MRIs for the presence of erosions, bone marrow edema, and synovitis. HR-pQCT images were also examined for the number, surface area, and volume of interruptions using a semiautomated algorithm.

Study participants with RA had significantly more interruptions and both a larger surface area and volume of interruptions in their metacarpophalangeal joints compared with controls (median 2.0, 1.42 mm2 and 0.48 mm3 vs 1.0, 0.69 mm2 and 0.23 mm3, respectively, all P <.01).

Findings on CR and MRI were significantly associated with more and larger interruptions on HR-pQCT (prevalence ratios [PRs], 1.03-7.74; all P <.01) in all participants.

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Participants with RA showed a significant association with more and larger interruptions on HR-pQCT (PRs, 2.33-5.39; all P <.01), even after adjusting for findings on CR or MRI.

“These findings demonstrate the value of HR-pQCT imaging in the evaluation of peri-articular bone and in the assessment of (early) bone damage in addition to CR and MRI in patients with RA,” the researchers wrote.

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Peters M, van Tubergen A, Scharmga A, et al. Assessment of cortical interruptions with semi-automated analysis of HR-pQCT images in finger joints of patients with rheumatoid arthritis versus healthy subjects and in comparison to radiography and MRI [published online May 11, 2018].  J Bone Miner Res. doi:10.1002/jbmr.3466