PT  - JOURNAL ARTICLE
AU  - Andrea Scharmga
AU  - Michiel Peters
AU  - Astrid van Tubergen
AU  - Joop van den Bergh
AU  - Cheryl Barnabe
AU  - Stephanie Finzel
AU  - Bert van Rietbergen
AU  - Piet Geusens
TI  - Heterogeneity of Cortical Breaks in Hand Joints of Patients with Rheumatoid Arthritis and Healthy Controls Imaged by High-resolution Peripheral Quantitative Computed Tomography
AID  - 10.3899/jrheum.160646
DP  - 2016 Oct 01
TA  - The Journal of Rheumatology
PG  - 1914--1920
VI  - 43
IP  - 10
4099  - http://www.jrheum.org/content/43/10/1914.short
4100  - http://www.jrheum.org/content/43/10/1914.full
SO  - J Rheumatol2016 Oct 01; 43
AB  - Objective. Conventional radiographs (CR) of the hands are the gold standard for imaging bone erosions. The presence of bone erosions, reflected by the presence of cortical breaks, is a poor prognostic factor in patients with rheumatoid arthritis (RA). The availability of high-resolution peripheral quantitative computed tomography (HR-pQCT) enables detailed investigation of cortical breaks in rheumatic diseases. The aim of this image review is to show HR-pQCT images of the spectrum of cortical breaks with and without underlying trabecular bone changes in metacarpophalangeal (MCP) joints of healthy controls (HC) and patients with RA, with corresponding images on CR and magnetic resonance imaging (MRI).Methods. Second and third MCP joints of 41 patients (of which 10 were early RA with ≤ 2 years and 24 longstanding RA with ≥ 10 years of disease duration) and 38 HC were imaged by CR, MRI, and HR-pQCT (XtremeCT1, Scanco Medical AG). Representative images of the spectrum of cortical breaks were selected.Results. Cortical breaks were found in early and longstanding RA, but also in HC. They were heterogeneous in size, location, and number per joint, with a variety of surrounding cortical and underlying trabecular bone characteristics.Conclusion. Using HR-pQCT images of MCP joints, heterogeneous cortical breaks with and without surrounding trabecular bone changes were found, not only in RA but also in HC. The underlying mechanisms and significance of this spectrum of cortical breaks as found with high 3-D resolution needs further investigation.