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Rheumatology Advance Access originally published online on June 24, 2009
Rheumatology 2009 48(9):1088-1091; doi:10.1093/rheumatology/kep169
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Bone mineral density in the hand as a predictor for mortality in patients with rheumatoid arthritis

Christina Book1, Jakob Algulin2, Jan-Åke Nilsson1, Tore Saxne3 and Lennart Jacobsson1

1Department of Rheumatology, Malmö University Hospital, Malmö, 2Sectra, Linköping and 3Department of Rheumatology, Lund University Hospital, Lund, Sweden.

Correspondence to: Christina Book, Department of Rheumatology, Malmö University Hospital, SE-205 02 Malmö, Sweden. E-mail: christina.book{at}med.lu.se


  Abstract

Objectives. BMD in the hand, as evaluated by digital X-ray radiogrammetry (DXR), has been suggested to be a predictor for joint damage in RA. A predictor for long-term prognosis might also predict increased mortality in RA. The aim of the present study was to evaluate BMD in the hand as a predictor for all-cause mortality.

Methods. In 1978, 152 consecutive patients (78% women, mean disease duration: 14.2 years) were enrolled. X-rays of the hands at inclusion were available in 108 patients. Reasons for not evaluating DXR in 24 patients 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. Measures of disease activity and damage were used to predict mortality by Cox regression models.

Results. From February 1978 through March 2008, 62 of the 82 patients died, corresponding to a standardized mortality ratio of 2.92 (95% CI 2.19, 3.65) for both sexes combined. In age- and sex-adjusted proportional hazards models, BMD [hazard ratio (HR) = 0.58/1 S.D.; 95% CI 0.37, 0.91], Steinbrocker functional class 3–4 (HR = 4.74/1 step; 95% CI 1.93, 11.64), the physician's global assessment (HR = 1.38/1 S.D.; 95% CI 1.03, 1.84) and ESR (HR = 1.92/1 S.D.; 95% CI 1.42, 2.58) were significant predictors of mortality, but RF, disease duration, Larsen index, Ritchie articular index and the patient's global assessment were not.

Conclusion. Low DXR-BMD predicted overall mortality in age- and sex-adjusted analyses, which further supports it as a valid measurement of disease activity or damage and as having prognostic value.

KEY WORDS: Rheumatoid arthritis, Digital X-ray radiogrammetry, Bone mineral density, Mortality, Predictor

Submitted 10 March 2009; revised version accepted 21 May 2009.
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