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Aktuelle Rheumatologie 2014; 39(06): 393-398
DOI: 10.1055/s-0034-1394423
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

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

The Hand Bone Mass as an Indicator for Structural Destruction in Patients with Rheumatoid Arthritis – Which Measurement Techniques Are Useful?
A. Pfeil
1   Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena
,
D. M. Renz
2   Klinik für Diagnostische Radiologie, Charité Universitätsmedizin Berlin, Campus Virchow Klinik, Berlin
,
P. Oelzner
1   Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena
,
A. Hansch
3   Institut für Diagnostische und Interventionelle Radiologie, Heinrich Braun Krankenhaus Zwickau, Zwickau
,
G. Lehmann
1   Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena
,
A. Malich
4   Südharz Klinikum Nordhausen gGmbH, Institut für Radiologie, Nordhausen
,
G. Wolf
1   Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena
,
J. Böttcher
5   Institut für Diagnostische und Interventionelle Radiologie, SRH Wald-Klinikum Gera, Gera
› Author Affiliations
Further Information

Publication History

Publication Date:
17 December 2014 (online)

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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
 

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