dxr-online offers an objective tool to identify patients with increased risk of joint destruction, and to avoid unnecessary drug treatment of patients with a more favorable prognosis
It is a well known fact that periarticular osteoporosis precedes erosions in RA. The very high precision of DXR makes it possible to make an accurate assessment of the bone destruction process and to identify those RA patients who have the greatest bone loss rate within a three-month period.
Early RA patients have been observed to demonstrate a sharp decline in DXR. The decline in DXR is associated with an increased risk of joint damage at one, two, five and ten years after the dxr-online prognosis [see references and below]. The association is strong and independent of other known risk factors such as biomarkers (anti-CCP) and joint destruction detectable at baseline.
Several independent studies show that bone loss measured with DXR predicts joint destruction in RA:
Odds Ratio (95% CI) |
|
Bone loss 1 year |
3.46(1.43-8.35) |
Adjusted for age, sex, anti-CCP, RF, CRP, disease duration, ESR, HAQ and Baseline vdH Sharp score.
Hoff M, Haugeberg G, Odegard S, Syversen SW, Landewé R, van der Heijde D, Kvien TK. Cortical hand bone loss after one year in early rheumatoid arthritis predicts radiographic hand joint damage at 5 and 10 year follow-up. Annals of the Rheumatic Diseases 2009 Mar;68(3):324-9.
OR (95% CI) |
|
Bone loss 1 year |
3.7(1.3-10.3) |
Adjusted for age, sex, symptom duration, ACPA, RF, CRP, BSE and anti-rheumatic and anti-resorptive treatment
Güler-Yüksel M, Klarenbeek NB, Gerards AH, van Krugten MV, Ronday HK, Huizinga TWJ, Dijkmans BA, Allaart CF, Lems WF. Cortical Hand Bone Mineral Density (BMD) Loss as Predictor of Progressive Joint Damage in Recent-onset
Rheumatoid Arthritis (RA). Arthritis Rheum 2008 (suppl) ACR 2008.
“In patients with high disease activity, significant DXR-BMD loss can be detected already after 1.5 months”
Short-time in-vitro and in-vivo precision of direct digital X-ray radiogrammetry Hoff M, Dhainaut A, Kvien TK, Forslind K, Kälvesten J , Haugeberg G J Clin Densitom. 2009 Jan-Mar;12(1):17-21.
