Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

Michael Platten, Yogan Kisten, Johan Kälvesten, Laurent Arnaud, Kristina Forslind, Ronald van Vollenhoven, Michael Platten, Yogan Kisten, Johan Kälvesten, Laurent Arnaud, Kristina Forslind, Ronald van Vollenhoven

Abstract

Objectives: To study fully automated digital joint space width (JSW) and bone mineral density (BMD) in relation to a conventional radiographic scoring method in early rheumatoid arthritis (eRA).

Methods: Radiographs scored by the modified Sharp van der Heijde score (SHS) in patients with eRA were acquired from the SWEdish FarmacOTherapy study. Fully automated JSW measurements of bilateral metacarpals 2, 3 and 4 were compared with the joint space narrowing (JSN) score in SHS. Multilevel mixed model statistics were applied to calculate the significance of the association between ΔJSW and ΔBMD over 1 year, and the JSW differences between damaged and undamaged joints as evaluated by the JSN.

Results: Based on 576 joints of 96 patients with eRA, a significant reduction from baseline to 1 year was observed in the JSW from 1.69 (±0.19) mm to 1.66 (±0.19) mm (p<0.01), and BMD from 0.583 (±0.068) g/cm2 to 0.566 (±0.074) g/cm2 (p<0.01). A significant positive association was observed between ΔJSW and ΔBMD over 1 year (p<0.0001). On an individual joint level, JSWs of undamaged (JSN=0) joints were wider than damaged (JSN>0) joints: 1.68 mm (95% CI 1.70 to 1.67) vs 1.54 mm (95% CI 1.63 to 1.46). Similarly the unadjusted multilevel model showed significant differences in JSW between undamaged (1.68 mm (95% CI 1.72 to 1.64)) and damaged joints (1.63 mm (95% CI 1.68 to 1.58)) (p=0.0048). This difference remained significant in the adjusted model: 1.66 mm (95% CI 1.70 to 1.61) vs 1.62 mm (95% CI 1.68 to 1.56) (p=0.042).

Conclusions: To measure the JSW with this fully automated digital tool may be useful as a quick and observer-independent application for evaluating cartilage damage in eRA.

Trial registration number: NCT00764725.

Keywords: Automated; Bone Mineral Density; Joint Space Width; Radiographic scoring; Rheumatoid Arthritis.

Conflict of interest statement

Competing interests: JK is employed by Sectra AB. No other conflicts of interests to declare.

Figures

Figure 1
Figure 1
Flow chart of patient selection.
Figure 2
Figure 2
Radiograph of hand with highlighted measurement regions. Posteroanterior radiograph of the left hand with measurement boxes placed at MCP 2, 3 and 4 in order to measure joint space width. Measurement boxes are also placed on the metacarpal bones 2, 3 and 4 in order to measure bone mineral density. MCP, metacarpophalangeal.
Figure 3
Figure 3
JSW, BMD and SHS at baseline and 12 months. Whiskers demonstrate SD of the mean. (A) Demonstrates the JSW of MCP 2, 3 and 4 at baseline and at 1 year. (B) Demonstrates the BMD of the left and right hand at baseline and at 1 year. (C) Demonstrates erosion score, JSN score and the SHS at baseline and at 1 year. *Significant difference, p

Figure 4

Distribution of joints with damage…

Figure 4

Distribution of joints with damage or no damage: raw data, unadjusted and adjusted…

Figure 4
Distribution of joints with damage or no damage: raw data, unadjusted and adjusted model. On an individual joint level, the JSW when a joint received a JSN score of 0 and when a joint received a JSN score of >0 for the raw data, as well as for the unadjusted and adjusted multilevel models, is illustrated. Whiskers represent 95% CI. *Significant difference, p
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References
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Figure 4
Figure 4
Distribution of joints with damage or no damage: raw data, unadjusted and adjusted model. On an individual joint level, the JSW when a joint received a JSN score of 0 and when a joint received a JSN score of >0 for the raw data, as well as for the unadjusted and adjusted multilevel models, is illustrated. Whiskers represent 95% CI. *Significant difference, p

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