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Rheumatoid arthritis
Original article
Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA
  1. Michael Platten1,
  2. Yogan Kisten1,
  3. Johan Kälvesten2,3,
  4. Laurent Arnaud1,
  5. Kristina Forslind4,5 and
  6. Ronald van Vollenhoven1,6
  1. 1 Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden
  2. 2 Medicine and Health Sciences, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
  3. 3 Sectra AB, Linköping, Sweden
  4. 4 Department of Medicine, Section of Rheumatology, Helsingborg's Hospital, Helsingborg, Sweden
  5. 5 Department of Clinical Sciences, Section of Rheumatology, Lund University, Helsingborg, Sweden
  6. 6 Departments of AMC, READE and VUmc, Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, Netherlands
  1. Correspondence to Michael Platten; michael.platten{at}stud.ki.se

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.

  • Joint Space Width
  • Rheumatoid Arthritis
  • Automated
  • Bone Mineral Density
  • Radiographic scoring

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2016-000369

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    Footnotes

    • Contributors MP led the writing of the manuscript, analysed data and interpreted results. YK participated in statistical analyses and interpretation of the results. JK was responsible for JSW measuring sampling and data recovery. LA participated in the statistical analyses and interpretation of the results. KF was responsible for the radiographic assessments including the scoring of radiographs. RvV inspired the study, designed it and contributed to analysis. All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. MP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This work was supported by grants from the Swedish Rheumatism Association, the Foundation for Assistance to Disabled People in Skåne (Stiftelsen för bistånd åt Rörelsehindrade i Skåne), Stockholm County, Schering-Plough/Merck Sharp and Dohme.

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

    • Ethics approval All patients gave their informed consent and the study was performed in accordance with the Declaration of Helsinki. Ethical approval for the present study was obtained from the ethical board in all participating units and was registered (NCT00764725).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Access to raw study data can be granted on contact with the main author.