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Aktuelle Rheumatologie 2012; 37(04): 248-253
DOI: 10.1055/s-0032-1304596
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Die periartikuläre Demineralisation bei Patienten mit Rheumatoider Arthritis – Klinischer Stellenwert der Digitalen Radiogrammetrie als neues Diagnoseverfahren

Periarticular Demineralisation in Patients with Rheumatoid Arthritis – Clinical Relevance of Digital X-Ray Radiogrammetry as a New Diagnostic Method
A. Pfeil
1   Klinik für Innere Medizin III, Friedrich Schiller Universität Jena
,
A. Hansch
2   Institut für Diagnostische und Interventionelle Radiologie, Friedrich-Schiller-Universität Jena, Jena
,
D. M. Renz
3   Campus Virchow, Klinik für Diagnostische Radiologie, Charité Universitätsmedizin Berlin, Berlin
,
A. Malich
4   Institut für Radiologie, Suedharzkrankenhaus Nordhausen, Nordhausen
,
G. Wolf
1   Klinik für Innere Medizin III, Friedrich Schiller Universität Jena
,
J. Böttcher
5   Institut für Diagnostische und Interventionelle Radiologie, SRH Wald-Klinikum Gera, Gera
› Author Affiliations
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Publication History

Publication Date:
15 March 2012 (online)

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Zusammenfassung

Die periartikuläre Demineralisation im Bereich der Hand- und Fingergelenke stellt eines der frühesten bildmorphologischen Stigmata der Rheumatoiden Arthritis dar. Ein ursächlicher Zusammenhang besteht zur inflammatorischen Aktivierung des RANKL/OPG-Systems und der Inhibierung des Wnt-Signalweges mit konsekutiv gesteigertem Knochenmasseverlust. Durch die klinische Etablierung und Weiterentwicklung der Digitalen Radiogrammetrie als computer-assistierte Diagnosetechnik ist die Quantifizierung der periartikulären Demineralisation nunmehr mit einer hohen Präzision und Reproduzierbarkeit zu gewährleisten. Die Digitale Radiogrammetrie ermöglicht die cross-sektionale als auch longitudinale Evaluierung der periartikulären Demineralisation als Surrogatparameter für eine radiologische und klinische Progression der Rheumatoiden Arthritis. Des Weiteren dient die periartikuläre Demineralisation, detektiert und quantifiziert mittels Digitaler Radiogrammetrie, als hoch sensitiver und spezifischer Marker für Therapieeffekte einer Basis- bzw. Biologika-Medikation und ermöglicht eine Aussage über die Effektivität einer individuell festgelegten Therapie.

Abstract

One of the earliest radiological signs of rheumatoid arthritis is the periarticular demineralisation of the finger and hand joints. The activation of the RANKL/OPG-system and the inhibition of the Wnt signalling is a consequence of the inflammatory process resulting in an increased loss of bone mass. The development and clinical refinement of digital X-ray radiogrammetry as a computer-assisted diagnostic technique now allows the quantification of periarticular bone loss with high precision and reproducibility. Digital X-ray radiogrammetry enables the cross-sectional and longitudinal evaluation of periarticular demineralisation as a surrogate marker of radiological and clinical progression in patients suffering from rheumatoid arthritis. Periarticular demineralisation detected and quantified by digital X-ray dadiogrammetry can be used to reveal therapeutic effects related to a DMARD or biological therapy and to elucidate the effectiveness of individually adapted therapeutic strategies.

Schlüsselwörter

Rheumatoide Arthritis - Digitale Radiogrammetrie - Knochenmineraldichte - periartikuläre Demineralisation

Key words

digital X-ray radiogrammetry - rheumatoid arthritis - bone mineral density - periarticular demineralization
 

  • Literatur

  • 1 Kapetanovic MC, Lindqvist E, Algulin J et al. Early changes in bone mineral density measured by digital X-ray radiogrammetry predict up to 20 years radiological outcome in rheumatoid arthritis. Arthritis Res Ther 2011; 13: R31
    CrossrefPubMedSearch in Google Scholar
  • 2 Backhaus M, Ohrndorf S, Kellner H et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum 2009; 61: 1194-1201
    CrossrefPubMedSearch in Google Scholar
  • 3 Goldbach-Mansky R, Mahadevan V, Yao L et al. The evaluation of bone damage in rheumatoid arthritis with magnetic resonance imaging. Clin Exp Rheumatol 2003; 21 (Suppl. 31) S50-S53
    PubMedSearch in Google Scholar
  • 4 van der Heijde DM. Radiographic imaging: the ‘gold standard’ for assessment of disease progression in rheumatoid arthritis. Rheumatology 2000; 39 (Suppl. 01) 9-16
    Search in Google Scholar
  • 5 Sharp JT, Young DY, Bluhm GB et al. How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis?. Arthritis Rheum 1985; 28: 1326-1335
    CrossrefPubMedSearch in Google Scholar
  • 6 Dias EM, Lukas C, Landewé R et al. Reliability and sensitivity to change of the Simple Erosion Narrowing Score compared with the Sharp-van der Heijde method for scoring radiographs in rheumatoid arthritis. Ann Rheum Dis 2008; 67: 375-379
    PubMedSearch in Google Scholar
  • 7 Langs G, Peloschek P, Bischof H et al. Automatic quantification of joint space narrowing and erosions in rheumatoid arthritis. IEEE Trans Med Imaging 2009; 28: 151-164
    CrossrefPubMedSearch in Google Scholar
  • 8 Pfeil A, Schäfer ML, Lehmann G et al. Implementation of Z-scores as an age- and sex-independent parameter for estimating joint space widths in rheumatoid arthritis. J Rheumatol 2009; 36: 717-723
    CrossrefPubMedSearch in Google Scholar
  • 9 Steinbroker O, Traeger CH, Batterman RC. Therapeutic criteria in rheumatoid arthritis. JAMA 1949; 140: 659-662
    CrossrefPubMedSearch in Google Scholar
  • 10 Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn 1977; 18: 481-491
    Search in Google Scholar
  • 11 Jergas M. Conventional radiographs and basic quantitative methods. In Grampp S. (ed.). Radiology of osteoporosis. Berlin: Springer; 2003: 62-64
    Search in Google Scholar
  • 12 Böttcher J, Malich A, Pfeil A et al. Potential clinical relevance of digital radiogrammetry for quantification of periarticular bone demineralisation in patients suffering from rheumatoid arthritis depending on severity and compared with DXA. Eur Radiol 2004; 14: 631-637
    CrossrefPubMedSearch in Google Scholar
  • 13 Malich A, Boettcher J, Pfeil A et al. The impact of technical conditions of X-ray imaging on reproducibility and precision of digital computer-assisted X-ray radiogrammetry (DXR). Skeletal Radiol 2004; 33: 698-703
    CrossrefPubMedSearch in Google Scholar
  • 14 Schett G, Saag KG, Bijlsma JWJ. From bone biology to clinical outcome: state of the art and future perspectives. Ann Rheum Dis 2010; 69: 1415-1419
    CrossrefPubMedSearch in Google Scholar
  • 15 Schett G. Osteoimmunology in rheumatic disease. Arthritis Res Ther 2009; 11: 210
    CrossrefPubMedSearch in Google Scholar
  • 16 Diarra D, Stolina M, Polzer K et al. Dickkopf-1 is a master regulator of joint remodeling. Nat Med 2007; 13: 156-163
    CrossrefPubMedSearch in Google Scholar
  • 17 Glass DA, Bialek P, Ahn JD et al. Canonical Wnt signaling in differentiated osteoblasts controls osteoclast differentiation. Dev Cell 2005; 8: 751-764
    CrossrefPubMedSearch in Google Scholar
  • 18 Hofbauer LC, Heufelder AE. Role of receptor activator of nuclear factor-κB ligand and osteoprotegerin in bone cell biology. J Mol Med 2001; 79: 243-253
    CrossrefPubMedSearch in Google Scholar
  • 19 Lam J, Takeshita S, Barker JE et al. TNF alpha induces osteoclastogenesis by direct stimulation of macrophages exposed to permissive levels of RANK ligand. J Clin Invest 2000; 106: 1481-1488
    CrossrefPubMedSearch in Google Scholar
  • 20 DVO-Leitlinie . zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei Erwachsenen. Osteologie 2009; 18: 304-328
    PubMedSearch in Google Scholar
  • 21 Forsblad-dElia H, Carlsten H. Bone mineral density by digital X-ray radiogrammetry is strongly decreased and associated with joint destruction in long-standing rheumatoid arthritis: a cross-sectional study. BMC Musculoskelet Disord 2011; 12: 242
    CrossrefPubMedSearch in Google Scholar
  • 22 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
    CrossrefPubMedSearch in Google Scholar
  • 23 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
    PubMedSearch in Google Scholar
  • 24 Böttcher J, Pfeil A, Heinrich B et al. Digital radiogrammetry as a new diagnostic tool for estimation of disease-related osteoporosis in rheumatoid arthritis compared with pQCT. Rheumatol Int 2005; 25: 457-464
    CrossrefPubMedSearch in Google Scholar
  • 25 Bejarano V, Hensor E, Green M et al. The 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
    CrossrefPubMedSearch in Google Scholar
  • 26 Rosholm A, Hyldstrup L, Baeksgaard L et al. Estimation of bone mineral density by digital X-ray radiogrammetry: theoretical background and clinical testing. Osteoporos Int 2001; 12: 961-969
    CrossrefPubMedSearch in Google Scholar
  • 27 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
    CrossrefPubMedSearch in Google Scholar
  • 28 Dhainaut A, Hoff M, Kälvesten J et al. Long-term in-vitro precision of direct digital X-ray radiogrammetry. Skeletal Radiol 2011; 40: 1561-1568
    PubMedSearch in Google Scholar
  • 29 Colt E, Kälvesten J, Cook K et al. The effect of fat on the measurement of bone mineral density by digital X-ray radiogrammetry (DXR-BMD). Int J Body Compos Res 2010; 8: 41-44
    PubMedSearch in Google Scholar
  • 30 Boyesen P, Haavardsholm EA, van der Heijde D et al. Prediction of MRI erosive progression: a comparison of modern imaging modalities in early rheumatoid arthritis patients. Ann Rheum Dis 2011; 70: 176-179
    CrossrefPubMedSearch in Google Scholar
  • 31 Stach CM, Bauerle M, Englbrecht M et al. Periarticular bone structure in rheumatoid arthritis patients and healthy individuals assessed by highresolution computed tomography. Arthritis Rheum 2010; 62: 330-339
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 33 Stewart A, Mackenzie LM, Black AJ et al. Predicting erosive disease in rheumatoid arthritis. A longitudinal study of changes in bone density using digital X-ray radiogrammetry: a pilot study. Rheumatology 2004; 43: 1561-1564
    CrossrefPubMedSearch in Google Scholar
  • 34 Bøyesen P, Hoff M, Odegård S et al. Antibodies to cyclic citrullinated protein and erythrocyte sedimentation rate predict hand bone loss in patients with rheumatoid arthritis of short duration: a longitudinal study. Arthritis Res Ther 2009; 11: R103
    CrossrefPubMedSearch in Google Scholar
  • 35 Hoff M, Bøyesen P, Haugeberg G et al. High disease activity is a predictor of cortical hand bone loss in post-menopausal patients with established rheumatoid arthritis: a 5-year multicentre longitudinal study. Rheumatology 2010; 49: 1676-1682
    CrossrefPubMedSearch in Google Scholar
  • 36 Hoff M, Haugeberg G, Kvien TK. Hand bone loss as an outcome measure in established rheumatoid arthritis: 2-year observational study comparing cortical and total bone loss. Arthritis Res Ther 2007; 9: R81
    CrossrefPubMedSearch in Google Scholar
  • 37 Hoff M, Haugeberg G, Ødegård S et al. Cortical hand bone loss after 1 year in early rheumatoid arthritis predicts radiographic hand joint damage at 5-year and 10-year follow-up. Ann Rheum Dis 2009; 68: 324-329
    CrossrefPubMedSearch in Google Scholar
  • 38 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
    CrossrefPubMedSearch in Google Scholar
  • 39 Pfeil A, Lippold J, Eidner T et al. Effects of leflunomide and methotrexate in rheumatoid arthritis detected by digital x-ray radiogrammetry and computer-aided joint space analysis. Rheumatol Int 2009; 29: 287-295
    CrossrefPubMedSearch in Google Scholar
  • 40 Urushibara M, Takayanagi H, Koga T et al. The antirheumatic drug leflunomide inhibits osteoclastogenesis by interfering with receptor activator of NF-kB ligand-stimulated induction of nuclear factor of activated T cells c1. Arthritis Rheum 2004; 50: 794-804
    CrossrefPubMedSearch in Google Scholar
  • 41 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
    CrossrefPubMedSearch in Google Scholar
  • 42 Emery P, Genovese MC, van Vollenhoven R et al. Less radiographic progression with adalimumab plus methotrexate versus methotrexate monotherapy across the spectrum of clinical response in early rheumatoid arthritis. J Rheumatol 2009; 36: 1429-1441
    CrossrefPubMedSearch in Google Scholar
  • 43 Smolen JS, Han C, van der Heijde DM et al. Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade. Ann Rheum Dis 2009; 68: 823-827
    CrossrefPubMedSearch in Google Scholar
  • 44 Hoff M, Kvien TK, Kälvesten J et al. Adalimumab reduces hand bone loss in rheumatoid arthritis independent of clinical response: subanalysis of the PREMIER study. BMC Musculoskelet Disord 2011; 12: 54
    CrossrefPubMedSearch in Google Scholar
  • 45 Schett G, Teitelbaum SL. Osteoclasts and arthritis. J Bone Miner Res 2009; 24: 1142-1146
    CrossrefPubMedSearch in Google Scholar
  • 46 Dirven LM, 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
    CrossrefPubMedSearch in Google Scholar