Orthopedics

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Bone mineral density in the hand as a predictor for mortality in patients with rheumatoid arthritis
Rheumatology, 06/29/09

Book C et al. – Findings demonstrate that low digital X-ray radiogrammetry-bone mineral density (DXR-BMD) predicted overall mortality in age- and sex-adjusted analyses; further supporting it as a valid measurement of disease activity or damage and as having prognostic value.

• Aim was to evaluate DXR-BMD in the hand as a predictor for all-cause mortality in RA pts
• 152 consecutive pts (78% women, mean disease duration: 14.2 yrs)
• X-rays of the hands at inclusion were available in 108 pts
• Reasons for not evaluating DXR in 24 pts were placement of joint prostheses or severe malalignment
• BMD was evaluated by DXR on the same digitized hand X-rays used for scoring radiographic joint damage

• 62 of the 82 pts died, corresponding to a standardized mortality ratio of 2.92 for both sexes combined
• In age- and sex-adjusted proportional hazards models, BMD, Steinbrocker functional class 3-4, the physician's global assessment, and ESR were significant predictors of mortality
• However RF, disease duration, Larsen index, Ritchie articular index and the patient's global assessment were not

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