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

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

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