LONGITUDINAL-STUDY OF HAND BONE DENSITOMETRY IN RHEUMATOID-ARTHRITIS

Objective. To measure hand bone mineral content (BMC) by dual x-ray ab sorptiometry and to seek clinical correlates in patients with rheumato id arthritis (RA), in a prospective, longitudinal study. Methods. Eigh ty-one patients with non-steroid-treated RA were assessed at baseline and at month 12, for hand BMC and for disease activity and severity. H and BMC in patients was compared with that in a control group of 95 no rmal volunteers, and rate of loss was compared with that in 37 control s. Results. At the initial assessment, male and female patients with R A had lower hand BMC than controls, after correction for age, height, and weight (mean reduction 7.5% in men [P = 0.003] and 7.8% in women [ P = 0.01]). After 1 year, there was a further loss of hand BMC in pati ents (median loss 3.25% in men [P = 0.001] and 1.46% in women [P = 0.0 5]), but normal controls did not have significant changes in their han d BMC. In patients with disease duration of <2 years at study entry, t he parameters of disease activity improved over 1 year, but they lost significant amounts of hand BMC. Hand BMC loss correlated with baselin e C-reactive protein levels. In those with RA of >2 years duration at entry, the Health Assessment Questionnaire scores and Larsen scores ha d worsened after 1 year, but there was no significant loss of hand BMC . Conclusion. Patients with RA had low hand BMC compared with normal c ontrols, even within 2 years of disease onset. The rate of loss was hi ghest in patients with early disease and correlated with measures of i nitial disease activity, This loss continued despite clinical improvem ent.