Hand Bone Mineral Density Is An Effective Predictor Of Mortality In Rheumatoid Arthritis

Low bone mineral density in the hand is a valid
predictor of overall mortality in patients with rheumatoid arthritis (RA) and indicates long-term
prognosis, according to a new study presented at EULAR 2008, the Annual Congress of
the European League Against Rheumatism in Paris, France. Digital X-ray radiogrammetry (DXR)
demonstrated bone mineral density to be as effective predicting mortality as well-established
means of assessment such as radiographic damage and functional disability.



During the study, different standard measures of disease activity were investigated in order to
assess their capacity to predict all-cause mortality. Over a period of 27 years (1978 - 2005), age-
sex adjusted proportional hazards models for 84 RA patients, found the following to be significant
predictors of mortality:
Bone mineral density in the hand (RR=0.55/1SD, 95% CI 0.35-0.87)


Steinbrocker functional classification (RR=1.86/1SD, 95% CI 1.35-2.56)


The physician's global assessment (RR=1.37/1SD, 95% CI 1.02-1.82)


Erythrocyte sedimentation rate (RR=1.86/1SD, 95% CI 1.41-2.46)

Conversely, during this study, certain measures of rheumatic disease activity, including
rheumatoid factor, Larsen index, Ritchie index and the patient's global assessment, were not
found to be significant predictors of mortality in RA.



The study's lead researcher, Dr Christina Book of Malmo?? University Hospital, Sweden, said: "This
long-term study establishes that measurement of bone mineral density in the hand may be an
important physical gauge in anticipating the course of rheumatoid arthritis. It offers physicians an
effective tool for assessing a patient's disease and so developing the most appropriate individual
management plan."



In the study, 152 consecutive patients (119 women, 33 men) with a mean disease duration of 13
years were enrolled. X-rays of the hands at inclusion were available in 108 patients, and in 84 of
these, bone mineral density was evaluated by DXR on the same digitised hand X-rays used for
scoring radiographic joint damage. Placement of joint prostheses or severe malalignment
prevented DXR evaluation in the other 24 patients. Manual measurements, such as dividing the
combined cortical thickness by the width of metacarpal II (CCTr) were performed in all 108
patients with X-rays at inclusion. Measures of disease activity and damage at inclusion in the 84
subjects were used to predict mortality by Cox regression models. Furthermore, standardised
mortality ratios were computed using the general Swedish population as a benchmark, to assess
the overall increased mortality in the group, which was three-folded increased.



Abstract number: OP0050



About EULAR


The European League Against Rheumatism (EULAR) is the organisation which represents
the patient, health professional and scientific societies of rheumatology of all the European
nations.


The aims of EULAR are to reduce the burden of rheumatic diseases on the individual and
society and to improve the treatment, prevention and rehabilitation of musculoskeletal
diseases. To this end, EULAR fosters excellence in education and research in the field of
rheumatology. It promotes the translation of research advances into daily care and fights for
the recognition of the needs of people with musculoskeletal diseases by the governing bodies
in Europe.


Diseases of bones and joints, such as rheumatoid arthritis and osteoarthritis cause disability
in 4 - 5 % of the adult population and are predicted to rise as people live longer.


As new treatments emerge and cellular mechanisms are discovered, EULAR 2008 brings
together more than 12,000 experts - scientists, clinicians, healthcare workers, pharmaceutical
companies and patients - to share their knowledge in a global endeavour to challenge the
pain and disability caused by musculo-skeletal disorders.



Author:

Dr Christina Book



To find out more information about the activities of EULAR, visit: eular