Die Knochenmasse der Hand als Indikator für die strukturelle Destruktion bei Patienten mit einer rheumatoiden Arthritis – welche Messmethoden sind geeignet?

Zusammenfassung

Die rheumatoide Arthritis (RA) ist als chronisch entzündliche Erkrankung mit einer periartikulären Demineralisation als krankheitsspezifisches Stigma gekennzeichnet. Hierbei ist eine hohe Krankheitsaktivität und eine entzündliche Manifestation an den peripheren Gelenkpartitionen mit einem periartikulären Knochenmasseverlust assoziiert. Die periartikuläre Demineralisation ist demzufolge mit der strukturellen Destruktion der RA-spezifisch involvierten Gelenke verbunden und ein Prädiktor für das Auftreten von Erosionen. Eine Bestimmung der periartikulären Demineralisation ist insbesondere durch die Digitale Radiogrammetrie (DXR), die Dual Energie X-ray Absorptiometry (DXA) und die hochauflösende periphere quantitative Computertomografie (HR-pQCT) quantifizierbar. Aufgrund einer verminderten Differenzierbarkeit zwischen der krankheitsspezifischen frühzeitigen periartikulären Demineralisation und einer systemischen sekundären Osteoporose als Spätfolge der RA kann anhand der aktuellen Daten eine Knochenmineraldichtemessung mittels DXA nicht favorisiert werden. Mittels DXR und HR-pQCT gelingt hingegen eine Bestimmung der Knochenmineraldichte an den Metakarpalknochen und im Bereich der Metakarpophalangealgelenke mit einer hohen Reproduzierbarkeit. Die exzellente Reproduzierbarkeit der DXR und der HR-pQCT ist die Vorraussetzung für eine präzise Quantifizierung der periartikulären Knochenmineraldichte mit der Möglichkeit einer Detektion von Therapieeffekten während der Behandlung einer RA.

Abstract

Rheumatoid arthritis (RA) as a chronic inflammatory disease is typically characterised by the periarticular demineralisation. Advanced disease activity with involvement of various peripheral articulations is associated with decreased periarticular bone mass. The periarticular demineralisation functions as surrogate marker of structural destruction of the inflamed joints and is a predictor for the occurrence of erosions. Digital X-ray radiogrammetry (DXR), dual energy X-ray absorptiometry (DXA) and high-resolution quantitative computed tomography (HR-pQCT) were used for the quantification of periarticular demineralisation. Because of the low discriminative power with limited differentiation between early periarticular bone loss and prolonged systemic secondary osteoporosis, DXA measurements were not favourable for the measurement of hand bone loss. Otherwise, DXR and HR-pQCT present high reproducibility in the quantification of bone mineral density at the metacarpal bones and adjacent to metacarpophalangeal joints. The excellent reproducibility of the DXR and HR-pQCT techniques is the basis for a precise quantification of periarticular demineralisation and also the detection of therapeutic effects during RA therapy.

Schlüsselwörter

Rheumatoide Arthritis - digitale Radiogrammetrie - Dual Energy X-ray Absorptiometry - hochauflösende periphere quantitative Computertomografie - Knochenmineraldichte

Key words

rheumatoid arthritis - digital X-ray radiogrammetry - dual energy X-ray absorptiometry - high resolution peripheral quantitative computed tomography - bone mineral density

• Literatur

• 1 McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med 2011; 365: 2205-2219
• 2 Töpfer D, Finzel S, Museyko O et al. Segmentation and quantification of bone erosions in high-resolution peripheral quantitative computed tomography datasets of the metacarpophalangeal joints of patients with rheumatoid arthritis. Rheumatology (Oxford) 2014; 53: 65-71
• 3 Østergaard M, Pedersen SJ, Døhn UM. Imaging in rheumatoid arthritis – status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol 2008; 22: 1019-1044
• 4 van der Heijde DM. Radiographic imaging: the ‘gold standard’ for assessment of disease progression in rheumatoid arthritis. Rheumatology (Oxford) 2000; 39 (Suppl. 1): 9-16
• 5 Landewé R, Strand V, van der Heijde D. From inhibition of radiographic progression to maintaining structural integrity: a methodological framework for radiographic progression in rheumatoid arthritis and psoriatic arthritis clinical trials. Ann Rheum Dis 2013; 72: 1113-1117
• 6 Alten R. Intracellular targets: current data on effectiveness and safety profile. Z Rheumatol 2013; 72: 867-872
• 7 van der Heijde D, Tanaka Y, Fleischmann R et al. Tofacitinib (CP-690,550) in patients with rheumatoid arthritis receiving methotrexate: twelve-month data from a twenty-four-month phase III randomized radiographic study. Arthritis Rheum 2013; 65: 559-570
• 8 Brower AC. Use of the radiograph to measure the course of rheumatoid arthritis. The gold standard versus fool’s gold. Arthritis Rheum 1990; 33: 316-324
• 9 Rehman Q, Lane NE. Bone loss. Therapeutic approaches for preventing bone loss in inflammatory arthritis. Arthritis Res 2001; 3: 221-227
• 10 Hofbauer LC, Lacey DL, Dunstan CR et al. Interleukin-1beta and tumor necrosis factor-alpha, but not interleukin-6, stimulate osteoprotegerin ligand gene expression in human osteoblastic cells. Bone 1999; 25: 255-259
• 11 Schett G. Osteoimmunology in rheumatic disease. Arthritis Res Ther 2009; 11: 210
• 12 Lories RJ, Luyten FP. Osteoimmunology: Wnt antagonists: for better or worse?. Nat Rev Rheumatol 2009; 5: 420-421
• 13 Vis M, Güler-Yüksel M, Lems WF. Can bone loss in rheumatoid arthritis be prevented. Osteoporos Int 2013; 24: 2541-2553
• 14 Alves C, Colin EM, van Oort WJ et al. Periarticular osteoporosis: a useful feature in the diagnosis of early rheumatoid arthritis? Reliability and validity in a cross-sectional diagnostic study using dual-energy X-ray absorptiometry. Rheumatology (Oxford) 2011; 50: 2257-2263
• 15 Fouque-Aubert A, Chapurlat R, Miossec P et al. A comparative review of the different techniques to assess hand bone damage in rheumatoid arthritis. Joint Bone Spine 2010; 77: 212-217
• 16 Naumann L, Hermann KG, Huscher D et al. Quantification of periarticular demineralization and synovialitis of the hand in rheumatoid arthritis patients. Osteoporos Int 2012; 23: 2671-2679
• 17 Black RJ, Spargo L, Schultz C et al. Decline in hand bone mineral density indicates increased risk of erosive change in early rheumatoid arthritis. Arthritis Care Res (Hoboken) 2014; 66: 515-522
• 18 Bejarano V, Hensor E, Green M et al. Relationship between early bone mineral density changes and long-term function and radiographic progression in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012; 64: 66-70
• 19 Devlin J, Lilley J, Gough A et al. Clinical associations of dual-energy X-ray absorptiometry measurement of hand bone mass in rheumatoid arthritis. Br J Rheumatol 1996; 35: 1256-1262
• 20 Pfeil A, Haugeberg G, Hansch A et al. The value of digital X-ray radiogrammetry in the assessment of inflammatory bone loss in rheumatoid arthritis. Arthritis Care Research (Hoboken) 2011; 63: 666-674
• 21 Pfeil A, Renz DM, Fröber R et al. Influence of angulation on metacarpal bone mineral density measurements using digital x-ray radiogrammetry. Int J Comput Assist Radiol Surg 2014; Epub ahead of print
• 22 Böttcher J, Pfeil A, Rosholm A et al. Influence of image-capturing parameters on Digital X-Ray Radiogrammetry. J Clin Densitom 2005; 8: 87-94
• 23 Böttcher J, Pfeil A, Rosholm A et al. Computerized quantification of joint space narrowing and periarticular demineralization in patients with rheumatoid arthritis based on digital x-ray radiogrammetry. Invest Radiol 2006; 41: 36-44
• 24 Böttcher J, Pfeil A, Rosholm A et al. Digital X-ray Radiogrammetry combined with semi-automated analysis of joint space distances as a new diagnostic approach in rheumatoid arthritis – A cross-sectional and longitudinal study. Arthritis Rheum 2005; 52: 3850-3859
• 25 Wevers-de Boer KV, Heimans L, Visser K et al. Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study. Ann Rheum Dis 2013; Epub ahead of print
• 26 Böttcher J, Pfeil A, Mentzel HJ et al. Peripheral bone status in rheumatoid arthritis evaluated by Digital X-ray Radiogrammetry (DXR) and compared with multi-site Quantitative Ultrasound (QUS). Calcif Tis Int 2006; 78: 25-34
• 27 Dirven L, Güler-Yüksel M, de Beus WM et al. Changes in hand bone mineral density and the association with the level of disease activity in patients with rheumatoid arthritis: bone mineral density measurements in a multicenter randomized clinical trial. Arthritis Care Res 2011; 63: 1691-1699
• 28 Hoff M, Kvien TK, Kälvesten J et al. Adalimumab therapy reduces hand bone loss in early rheumatoid arthritis: explorative analyses from the PREMIER study. Ann Rheum Dis 2009; 68: 1171-1176
• 29 Pfeil A, Oelzner P, Bornholdt K et al. Das LEMERADIX-Register: Vergleich der Basistherapie mit Leflunomid und Methotrexat bei rheumatoider Arthritis durch die Digitale Radiogrammetrie (DXR) und die Computergestützte Gelenkspaltweitemessung (CAJSA). Z Rheumatol 2011; 70 (Suppl 1): 73
• 30 Pfeil A, Oelzner P, Bornholdt K et al. Joint damage in rheumatoid arthritis: assessment of a new scoring method. Arthritis Res Ther 2013; 15: R27
• 31 Stach CM, Bäuerle M, Englbrecht M et al. Periarticular bone structure in rheumatoid arthritis patients and healthy individuals assessed by high-resolution computed tomography. Arthritis Rheum 2010; 62: 330-339
• 32 Finzel S, Ohrndorf S, Englbrecht M et al. A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions. Arthritis Rheum 2011; 63: 1231-1236
• 33 Macdonald HM, Nishiyama KK, Hanley DA et al. Changes in trabecular and cortical bone microarchitecture at peripheral sites associated with 18 months of teriparatide therapy in postmenopausal women with osteoporosis. Osteoporos Int 2011; 22: 357-362
• 34 Feehan L, Buie H, Li L et al. A customized protocol to assess bone quality in the metacarpal head, metacarpal shaft and distal radius: a high resolution peripheral quantitative computed tomography precision study. BMC Musculoskelet Disord 2013; 14: 367
• 35 Kocijan R, Finzel S, Englbrecht M et al. Decreased quantity and quality of the periarticular and nonperiarticular bone in patients with rheumatoid arthritis: a cross-sectional HR-pQCT study. J Bone Miner Res 2014; 29: 1005-1014
• 36 Fouque-Aubert A, Boutroy S, Marotte H et al. Assessment of hand bone loss in rheumatoid arthritis by high-resolution peripheral quantitative CT. Ann Rheum Dis 2010; 69: 1671-1676
• 37 Finzel S, Englbrecht M, Engelke K et al. A comparative study of periarticular bone lesions in rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis 2011; 70: 122-127
• 38 Kleyer A, Finzel S, Rech J et al. Bone loss before the clinical onset of rheumatoid arthritis in subjects with anticitrullinated protein antibodies. Ann Rheum Dis 2014; 73: 854-860
• 39 Albrecht A, Finzel S, Englbrecht M et al. The structural basis of MRI bone erosions: an assessment by microCT. Ann Rheum Dis 2013; 72: 1351-1357
• 40 Töpfer D, Finzel S, Museyko O et al. Segmentation and quantification of bone erosions in high-resolution peripheral quantitative computed tomography datasets of the metacarpophalangeal joints of patients with rheumatoid arthritis. Rheumatology (Oxford) 2014; 53: 65-71
• 41 Finzel S, Rech J, Schmidt S et al. Interleukin-6 receptor blockade induces limited repair of bone erosions in rheumatoid arthritis: a micro CT study. Ann Rheum Dis 2013; 72: 396-400