Q: How will DXR improve the prognostication of my patients?
A: Using DXR you will receive additional information about how your patient will likely do in the future. DXR is a predictor for future disease progression. Patients who in the very early stage of the disease have an increased bone loss measured with DXR have an odds ratio of 3.5-3.7 for developing future erosions (odds ratio adjusted for other risk factors such as aCCP and x-ray erosions at baseline).
Q: What is the added value of DXR to DAS?
A: DAS and DXR give information about two ongoing processes. DAS reflects the symptoms of the disease whereas DXR directly measures an underlying clinical process - rapid bone loss. DXR is an independent predictor for future erosions. DAS at baseline and three months follow up has in most studies not been found to be a significant predictor for future erosions but high DAS over a long period of time in combination with sharp fluctuations have been reported to be a significant predictor for future erosions.
Q: What is the difference between DXA and DXR?
A: Thanks to the high precision of the DXR measurement, the analysis can tell if there is a large change in BMD after only a short time which is not possible with hand DXA. DXR is validated to use as an early predictor for RA disease progression by determining hand BMD loss.
Studies of DXA of the central skeleton, hip and spine, have not shown any strong prognostic value for future erosions in RA. There are currently no such studies for hand DXA. The lower precision of the DXA measurement makes it unlikely to see such studies with short term measurements for bone change, since longer follow up time is required.
Q: Do I need any new equipment to start using dxr-online?
A: No. To use dxr-online you only need to write requests/referrals for DXR exams to your X-ray department who use existing equipment. There are no upfront costs for using dxr-online, it is a pay per analysis service.
