Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2002 Nov;61(11):1007–1011. doi: 10.1136/ard.61.11.1007

Assessing periarticular bone mineral density in patients with early psoriatic arthritis or rheumatoid arthritis

B Harrison 1, C Hutchinson 1, J Adams 1, I Bruce 1, A Herrick 1
PMCID: PMC1753932  PMID: 12379525

Abstract

Background: Periarticular osteoporosis is an early finding in the hands of patients with rheumatoid arthritis (RA), due to release of bone resorbing cytokines from the inflamed synovium. There has been disagreement as to whether periarticular bone loss occurs in psoriatic arthritis (PsA). Bone mineral density (BMD) can now be measured accurately using dual energy x ray absorptiometry (DEXA). Recently, DEXA has been used to measure periarticular BMD at predefined regions of interest (ROIs) around the joints.

Objectives: Firstly, to compare periarticular BMD around the finger joints of patients with early RA or PsA. Secondly, to determine whether periarticular bone loss is related to joint inflammation and radiological erosions in RA and PsA.

Methods: Seventeen patients with RA and 15 with PsA were recruited, all with disease duration of less than five years. All finger joints were examined by one person for swelling, or tenderness, or both. Hand radiographs were scored for the presence of erosions. Periarticular BMD was measured at 10 predetermined ROIs using a Hologic QDA-4500A fan-beam densitometer.

Results: Patients with PsA were less likely to be positive for rheumatoid factor (RF) (13% v 94%) and more likely to be men (60% v 23%) than patients with RA. There were no other clinical differences between patients with RA or PsA. Patients with RA had significantly lower BMD at each of the ROIs than those with PsA (p<0.05). However, these differences disappeared after adjusting for age and sex. Among patients with RA, those with a higher total number of swollen and/or tender hand joints had significantly lower periarticular BMD at the metocarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. No such association was found for patients with PsA.

Conclusions: In early disease, periarticular bone loss occurred both in patients with RA and those with PsA. Among patients with RA, periarticular osteoporosis was related to measures of joint inflammation. There was no association between joint inflammation and periarticular bone loss in patients with PsA, which lends support to the hypothesis that the primary site of inflammation in PsA is extrasynovial.

Full Text

The Full Text of this article is available as a PDF (140.5 KB).

Figure 1 .

Figure 1

Open in a new tab

Hand DEXA measurements using the Hologic QDA-4500A densitometer.

Figure 2 .

Figure 2

Open in a new tab

Predetermined regions of interest (ROIs) for BMD measurements taken from the non-dominant hand. Only regions from the third finger are shown.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AVILA R., PUGH D. G., SLOCUMB C. H., WINKELMANN R. K. Psoriatic arthritis: a roentgenologic study. Radiology. 1960 Nov;75:691–702. doi: 10.1148/75.5.691. [DOI] [PubMed] [Google Scholar]
  2. Alenfeld F. E., Diessel E., Brezger M., Sieper J., Felsenberg D., Braun J. Detailed analyses of periarticular osteoporosis in rheumatoid arthritis. Osteoporos Int. 2000;11(5):400–407. doi: 10.1007/s001980070106. [DOI] [PubMed] [Google Scholar]
  3. BYWATERS E. G. The early radiological signs of rheumatoid arthritis. Bull Rheum Dis. 1960 Nov;11:231–234. [PubMed] [Google Scholar]
  4. Backhaus M., Kamradt T., Sandrock D., Loreck D., Fritz J., Wolf K. J., Raber H., Hamm B., Burmester G. R., Bollow M. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum. 1999 Jun;42(6):1232–1245. doi: 10.1002/1529-0131(199906)42:6<1232::AID-ANR21>3.0.CO;2-3. [DOI] [PubMed] [Google Scholar]
  5. Bhalla A. K., Shenstone B. Bone densitometry measurements in early inflammatory disease. Baillieres Clin Rheumatol. 1992 Jun;6(2):405–414. doi: 10.1016/s0950-3579(05)80182-7. [DOI] [PubMed] [Google Scholar]
  6. Bogoch E., Gschwend N., Bogoch B., Rahn B., Perren S. Juxtaarticular bone loss in experimental inflammatory arthritis. J Orthop Res. 1988;6(5):648–656. doi: 10.1002/jor.1100060505. [DOI] [PubMed] [Google Scholar]
  7. Cooper C., Poll V., McLaren M., Daunt S. O., Cawley M. I. Alterations in appendicular skeletal mass in patients with rheumatoid, psoriatic, and osteoarthropathy. Ann Rheum Dis. 1988 Jun;47(6):481–484. doi: 10.1136/ard.47.6.481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Devlin J., Lilley J., Gough A., Huissoon A., Holder R., Reece R., Perkins P., Emery P. Clinical associations of dual-energy X-ray absorptiometry measurement of hand bone mass in rheumatoid arthritis. Br J Rheumatol. 1996 Dec;35(12):1256–1262. doi: 10.1093/rheumatology/35.12.1256. [DOI] [PubMed] [Google Scholar]
  9. Frediani B., Allegri A., Falsetti P., Storri L., Bisogno S., Baldi F., Filipponi P., Marcolongo R. Bone mineral density in patients with psoriatic arthritis. J Rheumatol. 2001 Jan;28(1):138–143. [PubMed] [Google Scholar]
  10. Harrison B. J., Silman A. J., Barrett E. M., Scott D. G., Symmons D. P. Presence of psoriasis does not influence the presentation or short-term outcome of patients with early inflammatory polyarthritis. J Rheumatol. 1997 Sep;24(9):1744–1749. [PubMed] [Google Scholar]
  11. Hein G., Schmidt F., Barta U., Müller A. Is there a psoriatic osteopathy? -- the activity of bone resorption in psoriatics is related to inflammatory joint process. Eur J Med Res. 1999 May 26;4(5):187–192. [PubMed] [Google Scholar]
  12. Jevtic V., Watt I., Rozman B., Kos-Golja M., Demsar F., Jarh O. Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol. 1995 Jul;24(5):351–355. doi: 10.1007/BF00197064. [DOI] [PubMed] [Google Scholar]
  13. Joffe I., Epstein S. Osteoporosis associated with rheumatoid arthritis: pathogenesis and management. Semin Arthritis Rheum. 1991 Feb;20(4):256–272. doi: 10.1016/0049-0172(91)90021-q. [DOI] [PubMed] [Google Scholar]
  14. Jørgensen J. T., Andersen P. B., Rosholm A., Bjarnason N. H. Digital X-ray radiogrammetry: a new appendicular bone densitometric method with high precision. Clin Physiol. 2000 Sep;20(5):330–335. doi: 10.1046/j.1365-2281.2000.00268.x. [DOI] [PubMed] [Google Scholar]
  15. Mawer E. B., Hayes M. E., Still P. E., Davies M., Lumb G. A., Palit J., Holt P. J. Evidence for nonrenal synthesis of 1,25-dihydroxyvitamin D in patients with inflammatory arthritis. J Bone Miner Res. 1991 Jul;6(7):733–739. doi: 10.1002/jbmr.5650060711. [DOI] [PubMed] [Google Scholar]
  16. McGonagle D., Gibbon W., Emery P. Classification of inflammatory arthritis by enthesitis. Lancet. 1998 Oct 3;352(9134):1137–1140. doi: 10.1016/S0140-6736(97)12004-9. [DOI] [PubMed] [Google Scholar]
  17. Nilsson B., Nilsson U. R., Karlsson-Parra A., Sjölin-Forsberg G., Hällgren R. Reconstitution of the alternative pathway of complement by plasma infusions given to a patient with an SLE-like syndrome associated with a hereditary C3 dysfunction. Ann Rheum Dis. 1994 Oct;53(10):691–694. doi: 10.1136/ard.53.10.691. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Nolla J. M., Fiter J., Rozadilla A., Gomez-Vaquero C., Mateo L., Rodriguez-Moreno J., Roig-Escofet D. Bone mineral density in patients with peripheral psoriatic arthritis. Rev Rhum Engl Ed. 1999 Oct;66(10):457–461. [PubMed] [Google Scholar]
  19. Peel N. F., Spittlehouse A. J., Bax D. E., Eastell R. Bone mineral density of the hand in rheumatoid arthritis. Arthritis Rheum. 1994 Jul;37(7):983–991. doi: 10.1002/art.1780370702. [DOI] [PubMed] [Google Scholar]
  20. Reid D. M., Kennedy N. S., Nicoll J., Smith M. A., Tothill P., Nuki G. Total and peripheral bone mass in patients with psoriatic arthritis and rheumatoid arthritis. Clin Rheumatol. 1986 Sep;5(3):372–378. doi: 10.1007/BF02054256. [DOI] [PubMed] [Google Scholar]
  21. Resnick D. Radiology of seronegative spondyloarthropathies. Clin Orthop Relat Res. 1979 Sep;(143):38–45. [PubMed] [Google Scholar]
  22. Ronday H. K., Te Koppele J. M., Greenwald R. A., Moak S. A., De Roos J. A., Dijkmans B. A., Breedveld F. C., Verheijen J. H. Tranexamic acid, an inhibitor of plasminogen activation, reduces urinary collagen cross-link excretion in both experimental and rheumatoid arthritis. Br J Rheumatol. 1998 Jan;37(1):34–38. doi: 10.1093/rheumatology/37.1.34. [DOI] [PubMed] [Google Scholar]
  23. Röben P., Barkmann R., Ullrich S., Gause A., Heller M., Glüer C. C. Assessment of phalangeal bone loss in patients with rheumatoid arthritis by quantitative ultrasound. Ann Rheum Dis. 2001 Jul;60(7):670–677. doi: 10.1136/ard.60.7.670. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. SOILA P. THE CAUSAL RELATIONS OF RHEUMATOID DISINTEGRATION OF JUXTA-ARTICULAR BONE TRABECULAE: A RADIOGRAPHIC STUDY. Acta Rheumatol Scand. 1963;9:231–236. [PubMed] [Google Scholar]
  25. Shimizu S., Shiozawa S., Shiozawa K., Imura S., Fujita T. Quantitative histologic studies on the pathogenesis of periarticular osteoporosis in rheumatoid arthritis. Arthritis Rheum. 1985 Jan;28(1):25–31. doi: 10.1002/art.1780280105. [DOI] [PubMed] [Google Scholar]
  26. WRIGHT V. Psoriatic arthritis. A comparative radiographic study of rheumatoid arthritis and arthritis associated with psoriasis. Ann Rheum Dis. 1961 Jun;20:123–132. doi: 10.1136/ard.20.2.123. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES