Generalized bone loss as a predictor of three-year radiographic damage in African American patients with recent-onset rheumatoid arthritis

Arthritis Rheum. 2010 Aug;62(8):2219-26. doi: 10.1002/art.27510.


Objective: To examine the association between baseline bone mineral density (BMD) and radiographic damage at 3 years of disease duration in a longitudinal cohort of African Americans with recent-onset rheumatoid arthritis (RA).

Methods: African American RA patients with a disease duration of <2 years (n = 141) were included in the study. All patients underwent baseline BMD measurements (femoral neck and/or lumbar spine) using dual x-ray absorptiometry. T scores were calculated using normative data from the general population of African Americans. Patients were categorized as having osteopenia/osteoporosis (T score less than or equal to -1) or as being healthy. Hand and wrist radiographs, obtained at baseline and at 3 years of disease duration, were scored using the modified Sharp/van der Heijde method. The association between baseline BMD and total radiographic score at 3 years of disease was examined using multivariable negative binomial regression.

Results: At baseline, the mean age and the mean disease duration were 52.4 years and 14.8 months, respectively; 85.1% of the patients were women. The average total radiographic scores at baseline and at 3 years of disease were 2.4 and 5.7, respectively. In the final reduced multivariable model, adjusting for age, sex, anti-cyclic citrullinated peptide antibody positivity, and the presence of radiographic damage at baseline, the total radiographic score at 3 years disease in patients with osteopenia/osteoporosis of the femoral neck was twice that in patients with normal bone density, and the difference was statistically significant (P = 0.0084). No association between lumbar spine osteopenia/osteoporosis and radiographic score was found.

Conclusion: Our findings suggest that reduced generalized BMD may be a predictor of future radiographic damage and support the hypothesis that radiographic damage and reduced generalized BMD in RA patients may share a common pathogenic mechanism.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Arthritis, Rheumatoid / diagnostic imaging*
  • Arthritis, Rheumatoid / pathology
  • Black or African American
  • Bone Density*
  • Disease Progression
  • Female
  • Hand / diagnostic imaging*
  • Hand / pathology
  • Humans
  • Male
  • Middle Aged
  • Osteoporosis / diagnostic imaging*
  • Osteoporosis / pathology
  • Predictive Value of Tests
  • Radiography
  • Severity of Illness Index
  • Wrist Joint / diagnostic imaging*
  • Wrist Joint / pathology