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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2001 Jul;60(7):670–677. doi: 10.1136/ard.60.7.670

Assessment of phalangeal bone loss in patients with rheumatoid arthritis by quantitative ultrasound

P Roben 1, R Barkmann 1, S Ullrich 1, A Gause 1, M Heller 1, C Gluer 1
PMCID: PMC1753730  PMID: 11406521

Abstract

OBJECTIVE—Periarticular osteopenia is an early radiological sign of rheumatoid arthritis (RA). Quantitative ultrasound (QUS) devices have recently been shown to be useful for assessing osteoporosis. In this study the capability of a transportable and easy to use QUS device to detect skeletal impairment of the finger phalanges in patients with RA was investigated.
METHODS—In a cross sectional study 83 women (30 controls, 29 with glucocorticosteroid (GC) treated RA, and 24 with GC treated vasculitis) were examined. QUS measurements were obtained at the metaphyses of the proximal phalanges II-V and directly at the proximal interphalangeal joints II-IV with a DBM Sonic 1200 (IGEA, Italy) QUS device. Amplitude dependent speed of sound (AD-SoS) was evaluated. In 23 of the patients with RA, hand radiographs were evaluated.
RESULTS—Significant differences between patients with RA and the other groups were found for AD-SoS at both measurement sites. Compared with age matched controls, the AD-SoS of patients with RA was lowered by two and three standard deviations at the metaphysis and joint, respectively. Fingers of patients with RA without erosions (Larsen score 0-I) already had significantly decreased QUS values, which deteriorated further with the development of erosions (Larsen II-V).
CONCLUSION—This study indicates that QUS is sensitive to phalangeal periarticular bone loss in RA. QUS is a quick, simple, and inexpensive method free of ionising radiation that appears to be suited to detection of early stages of periarticular bone loss. Its clinical use in the assessment of early RA should be further evaluated in prospective studies.



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Figure 1  .

Figure 1  

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Principle of quantitative ultrasound measurement using the DBM Sonic 1200. The generated ultrasound signal (left) is transmitted through the finger (middle). The received signal (right) is displayed and evaluated: A = metaphysis of the proximal phalanx II of a healthy woman, 47 years old with AD-SoS=2082 m/s; B = measurement at the same site of a 50 year old woman who had had rheumatoid arthritis for 11 years with AD-SoS=1728 m/s. Marker 1: At this point in time the signal intensity reached the trigger level to measure AD-SoS.

Figure 2  .

Figure 2  

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(A) Measurement at the metaphysis of the proximal phalanx II (standard mode). (B) Dorsovolar measurement at the proximal interphalangeal joint. The probes are positioned by palpation of the joint gap.

Figure 3  .

Figure 3  

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Hand x ray. This example of the evaluation of proximal interphalangeal joints depicts how cortical index and joint gap narrowing were determined. Cortical thickness was measured 6 mm proximal to the widening of the epiphysial head because this is the site where the ultrasound beam penetrates the finger in the standard measurement mode.

Figure 4  .

Figure 4  

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Correlation between AD-SoS at metaphysis and cortical index. (R2=0.71, p<0.0001). Displayed are the mean values averaged across six fingers (left and right phalanx II-IV) for 23 patients with RA, the linear regression line, and the 95% confidence intervals of the regression line.

Figure 5  .

Figure 5  

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Age adjusted and finger specific QUS Z scores for fingers with and without erosions compared with healthy controls (based on subjects for whom radiographs were available). Ultrasound velocity of RA fingers with erosions is significantly decreased compared with those without erosions. This result is found at both measurement sites. The diamonds represent the 95% confidence interval (height of the diamond) of the mean (horizontal centre line).

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