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Does digital X-ray radiogrammetry have a role in identifying patients at increased risk for joint destruction in early rheumatoid arthritis?
Helsingborg, Hospital, Helsingborg and University Hospital, Lund.
Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Faculty of Health Sciences.
Karolinska University Hospital.
Helsingborg, Hospital, Helsingborg and University Hospital, Lund.
2012 (English)In: Arthritis Research & Therapy, ISSN 1478-6362, Vol. 14, no 5, R219- p.Article in journal (Refereed) Published
Abstract [en]


The aim of this study was to investigate the role of hand bone mineral density (BMD) loss analyzed with digital X-ray radiogrammetry (DXR) in early rheumatoid arthritis (RA) as a predictor for progression of joint damage.


In 379 patients with early RA, baseline and one-year hand BMD was measured with DXR and the hand bone loss (HBL) was analyzed using the smallest detectable change (HBLsdc) and tertiles (HBLtertiles). Joint damage in hands and feet were scored according to the Sharp van der Heijde (SHS) method at baseline and at one, two, five and eight years. At the same time-points Disease Activity Score (DAS28) was calculated and functional disability assessed. Rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) were analyzed at baseline.


Sixty-six percent of the patients had hand BMD loss in the first year of RA determined by HBLsdc and 65% by HBLtertiles. Radiographic progression after two, five and eight years was associated with hand bone loss defined by HBLsdc. By HBLtertiles there were significant associations at all time-points except at eight years. The change in DXR at one year (ChDXR1yr) correlated significantly and inversely with the change in SHS (ChSHS) at two, five and eight years. Multivariate analysis showed that only change in SHS during the first year and the presence of anti-CCP were independent predictors of long-term progressive joint damage. If radiographic scores were not included, DXR-BMD loss was an independent predictor. Patients with great bone loss by HBLtertiles had significantly more often high disease activity after two years. However, neither bone loss by HBLsdc or HBLtertiles nor by ChDXR1yr was an independent predictor of remission after two, five and eight years.


This study confirms previous reports of an association of decrease in DXR-BMD during the first disease year with progression of radiographic joint damage over an extended period of time. This association was independent in a regression model only when radiological findings were excluded suggesting a possible predictive role of DXR-BMD in clinical practice when radiographic evaluation is not available. However, further studies are required before this can be established.

Place, publisher, year, edition, pages
2012. Vol. 14, no 5, R219- p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-90097DOI: 10.1186/ar4058ISI: 000315488700031OAI: diva2:612022
Available from: 2013-03-19 Created: 2013-03-19 Last updated: 2015-02-20
In thesis
1. Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis
Open this publication in new window or tab >>Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Low-energy trauma and fragility fractures represent a major public health problem. The societal cost of the fragility fractures that occurred in Sweden 2010 has been estimated at €4 billion.

In rheumatoid arthritis (RA), patient outcomes have improved greatly in recent years. However, the therapeutic decision making is still hampered by a lack of effective validated biomarkers. The cost of RA in Sweden 2010 has been estimated at €600 million, of which biologic drugs was €180 million.

Digital X-ray radiogrammetry (DXR) is a method to measure bone mineral density (BMD) in the metacarpals of the hand. It can be applied opportunistically in several workflows where a person is already at an X-ray machine, including fracture repositioning follow up, mammography screening and hand imaging in RA. This thesis explored DXR-BMD as a marker to identify individuals who would benefit from anti-osteoporotic treatment, change rate of DXR-BMD as a biomarker in RA and under what conditions historical X-ray images can be used to estimate DXR-BMD. An automated method for measurement of joint space width in metacarpophalangeal and interphalangeal joints was also developed and evaluated as a biomarker in RA.

Low DXR-BMD was predictive for hip fractures and predicted fragility fractures to a comparable degree as other BMD measurement sites. Rapid decrease of DXR-BMD was a strong and independent predictor for progression of radiographic damage in RA when manual radiographic progression scores were not available. Change of metacarpal joint space width was a statistically significant but weak predictor of joint space narrowing score progression. Guidelines and considerations for use of historical X-ray radiographs for DXR-BMD measurements in clinical trials have been developed and published.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 57 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1433
Osteoporosis, rheumatoid arthritis, digital X-ray radiogrammetry, joint space width, bone densitometry
National Category
Medical Image Processing
urn:nbn:se:liu:diva-113680 (URN)10.3384/diss.diva-113680 (DOI)978-91-7519-170-6 (print) (ISBN)
Public defence
2015-03-13, Wrannesalen, CMIV, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Available from: 2015-01-28 Created: 2015-01-28 Last updated: 2015-03-26Bibliographically approved

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